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Saini R, Jeyaraman M, Jeyaraman N, Jain VK, Ramasubramanian S, Iyengar KP. Advancing orthopaedic trauma care through WhatsApp: An analysis of clinical and non-clinical applications, challenges, and future directions. World J Orthop 2024; 15:529-538. [PMID: 38947267 PMCID: PMC11212534 DOI: 10.5312/wjo.v15.i6.529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 04/23/2024] [Accepted: 05/13/2024] [Indexed: 06/12/2024] Open
Abstract
The integration of WhatsApp, a widely-used instant messaging application (IMA), into the realm of orthopaedics and trauma surgery has emerged as a significant development in recent years. This paper explores the multifaceted role of WhatsApp in orthopaedics, focusing on its clinical and non-clinical applications, advantages, disadvantages, and future prospects. The study synthesizes findings from various research papers, emphasizing the growing reliance on mobile technology in healthcare. WhatsApp's role in orthopaedics is notable for its ease of use, real-time communication, and accessibility. Clinically, it facilitates triage, teleconsultation, diagnosis, treatment, patient advice, and post-operative monitoring. Non-clinically, it supports telemedicine, teleradiology, virtual fracture clinics, research, and education in orthopaedic surgery. The application has proven beneficial in enhancing communication among healthcare teams, providing quick responses, and motivating junior physicians. Its use in educational settings has been shown to improve learner's understanding and patient care. However, the use of WhatsApp in orthopaedics is not without challenges. Risks include the potential spread of misleading information, privacy concerns, and issues with image quality affecting diagnosis and treatment decisions. The paper acknowledges the importance of maintaining professional boundaries and the need for oversight measures to ensure content accuracy. Looking forward, the potential of WhatsApp and similar IMAs in orthopaedics lies in their ability to streamline data collection and retrieval, improve doctor-patient communication, and address challenges like bureaucratic red tape and limited resources. The paper suggests that future orthopaedic practice, particularly in emergency departments, will increasingly rely on such technologies for efficient patient management. This shift, however, must be approached with an understanding of the ethical, legal, and practical implications of integrating social media and mobile technology in healthcare.
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Affiliation(s)
- Ravi Saini
- Department of Orthopaedics, Atal Bihari Vajpayee Institute of Medical Sciences, Dr Ram Manohar Lohia Hospital, New Delhi 110001, India
| | - Madhan Jeyaraman
- Department of Orthopaedics, ACS Medical College and Hospital, Dr MGR Educational and Research Institute, Chennai 600077, Tamil Nadu, India
| | - Naveen Jeyaraman
- Department of Orthopaedics, ACS Medical College and Hospital, Dr MGR Educational and Research Institute, Chennai 600077, Tamil Nadu, India
| | - Vijay Kumar Jain
- Department of Orthopaedics, Atal Bihari Vajpayee Institute of Medical Sciences, Dr Ram Manohar Lohia Hospital, New Delhi 110001, India
| | - Swaminathan Ramasubramanian
- Department of Orthopaedics, Government Medical College, Omandurar Government Estate, Chennai 600002, Tamil Nadu, India
| | - Karthikeyan P Iyengar
- Department of Trauma and Orthopaedics, Southport and Ormskirk Hospitals, Mersey and West Lancashire Teaching NHS Trust, Southport PR8 6PN, United Kingdom
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Youssef E, Benabbas R, Choe B, Doukas D, Taitt HA, Verma R, Zehtabchi S. Interventions to improve emergency department throughput and care delivery indicators: A systematic review and meta-analysis. Acad Emerg Med 2024. [PMID: 38826092 DOI: 10.1111/acem.14946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 04/19/2024] [Accepted: 05/10/2024] [Indexed: 06/04/2024]
Abstract
BACKGROUND Emergency department (ED) crowding has repercussions on acute care, contributing to prolonged wait times, length of stay, and left without being seen (LWBS). These indicators are regarded as systemic shortcomings, reflecting a failure to provide equitable and accessible acute care. The objective was to evaluate the effectiveness of interventions aimed at improving ED care delivery indicators. METHODS This was a systematic review and meta-analysis of randomized controlled trials (RCTs) assessing ED interventions aimed at reducing key metrics of time to provider (TTP), time to disposition (TTD), and LWBS. We excluded disease-specific trials (e.g., stroke). We used Cochrane's revised tool to assess the risk of bias and Grading of Recommendations, Assessment, Development, and Evaluations to rate the quality of evidence. The meta-analysis was performed using a random-effects model and Cochrane Q test for heterogeneity. Data were summarized as means (±SD) for continuous variables and risk ratios (RR) with 95% confidence intervals (CIs). RESULTS We searched MEDLINE, EMBASE, and other major databases. A total of 1850 references were scanned and 20 RCTs were selected for inclusion. The trials reported at least one of the three outcomes of TTD, TTP, or LWBS. Most interventions focused on triage liaison physician and point-of-care (POC) testing. Others included upfront expedited workup (ordering tests before full evaluation by a provider), scribes, triage kiosks, and sending notifications to consultants or residents. POC testing decreased TTD by an average of 5-96 min (high heterogeneity) but slightly increased TTP by a mean difference of 2 min (95% CI 0.6-4 min). Utilizing a triage liaison physician reduced TTD by 28 min (95% CI 19-37 min; moderate-quality evidence) and was more effective in reducing LWBS than routine triage (RR 0.76, 95% CI 0.66-0.88; moderate quality). CONCLUSIONS Operational strategies such as POC testing and triage liaison physicians could mitigate the impact of ED crowding and appear to be effective. The current evidence supports these strategies when tailored to the appropriate practice environment.
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Affiliation(s)
- Elias Youssef
- Department of Emergency Medicine, New York Health + Hospitals/Kings County Hospital, Brooklyn, New York, USA
| | - Roshanak Benabbas
- Department of Emergency Medicine, New York Health + Hospitals/Kings County Hospital, Brooklyn, New York, USA
| | - Brittany Choe
- Department of Emergency Medicine, New York Health + Hospitals/Kings County Hospital, Brooklyn, New York, USA
| | - Donald Doukas
- Department of Emergency Medicine, New York Health + Hospitals/Kings County Hospital, Brooklyn, New York, USA
| | - Hope A Taitt
- Department of Emergency Medicine, New York Health + Hospitals/Kings County Hospital, Brooklyn, New York, USA
| | - Rajesh Verma
- Department of Emergency Medicine, New York Health + Hospitals/Kings County Hospital, Brooklyn, New York, USA
| | - Shahriar Zehtabchi
- Department of Emergency Medicine, New York Health + Hospitals/Kings County Hospital, Brooklyn, New York, USA
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Small W, Iturrate E, Austrian J, Genes N. Electronic Health Record Messaging Patterns of Health Care Professionals in Inpatient Medicine. JAMA Netw Open 2023; 6:e2349136. [PMID: 38147337 PMCID: PMC10751588 DOI: 10.1001/jamanetworkopen.2023.49136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 11/07/2023] [Indexed: 12/27/2023] Open
Abstract
This cross-sectional study examines secure messaging patterns among health care professionals in the internal medicine inpatient setting.
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Affiliation(s)
- William Small
- New York University Grossman School of Medicine, New York, New York
| | - Eduardo Iturrate
- New York University Grossman School of Medicine, New York, New York
| | | | - Nicholas Genes
- New York University Grossman School of Medicine, New York, New York
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4
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Voaklander B, Gaudet LA, Kirkland SW, Keto-Lambert D, Villa-Roel C, Rowe BH. Interventions to improve consultations in the emergency department: A systematic review. Acad Emerg Med 2022; 29:1475-1495. [PMID: 35546740 DOI: 10.1111/acem.14520] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 04/21/2022] [Accepted: 05/07/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Emergency department (ED) consultations with specialists are necessary for safe and effective patient care. Delays in the ED consultation process, however, have been shown to increase ED length of stay (LOS) and contribute to ED crowding. This review aims to describe and evaluate the effectiveness of interventions to improve the ED consultation process. METHODS Eight primary literature databases and the gray literature were searched to identify comparative studies assessing ED-based interventions to improve the specialist consultation process. Two independent reviewers identified eligible studies, assessed study quality, and extracted data. Individual or pooled meta-analysis for continuous outcomes were calculated as mean differences (MDs) with 95% confidence intervals (CIs) using a random-effects model was conducted. RESULTS Thirty-five unique comparative intervention studies were included. While the interventions varied, four common components/themes were identified including interventions to improve consultant responsiveness (n = 11), improve access to consultants in the ED (n = 9), expedite ED consultations (n = 8), and bypass ED consultations (n = 7). Studies on interventions to improve consult responsiveness consistently reported a decrease in consult response times in the intervention group with percent changes between 10% and 71%. Studies implementing interventions to improve consult responsiveness (MD -2.55, 95% CI -4.88 to -0.22) and interventions to bypass ED consultations (MD -0.99, 95% CI -1.43 to -0.56) consistently reported a decrease in ED LOS; however, heterogeneity was high (I2 = 99%). Evidence on whether any of the interventions were effective at reducing the proportion of patients consulted or subsequently admitted varied. CONCLUSIONS The various interventions impacting the consultation process were predominately successful in reducing ED LOS, with evidence suggesting that interventions improving consult responsiveness and improving access to consultants in the ED also improve consult response times. Health care providers looking to implement interventions to improve the ED consultation process should identify key areas in their setting that could be targeted.
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Affiliation(s)
- Britt Voaklander
- Michael G. DeGroote School of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Lindsay A Gaudet
- Alberta Research Centre for Health Evidence, University of Alberta, Edmonton, Alberta, Canada
| | - Scott W Kirkland
- Department of Emergency Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Diana Keto-Lambert
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Cristina Villa-Roel
- Department of Emergency Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Brian H Rowe
- Department of Emergency Medicine, University of Alberta, Edmonton, Alberta, Canada.,School of Public Health, University of Alberta, Edmonton, Alberta, Canada
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Schütze D, Engler F, Nohl-Deryk P, Müller B, Müller A. Implementierung einer Secure Instant Messaging-App in der COVID-19 Pandemie: Nutzungserfahrungen von Hausärzt*innen und Mitarbeiter*innen von Gesundheitsämtern. ZEITSCHRIFT FÜR EVIDENZ, FORTBILDUNG UND QUALITÄT IM GESUNDHEITSWESEN 2022; 173:40-48. [PMID: 35780042 PMCID: PMC9242843 DOI: 10.1016/j.zefq.2022.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 03/16/2022] [Accepted: 04/12/2022] [Indexed: 11/24/2022]
Abstract
Hintergrund Insbesondere zu Beginn der COVID-19-Pandemie klagten hausärztliche Praxen über eine für sie unsichere Informationslage und in diesem Zusammenhang über einen unzureichenden Informationsfluss von den zuständigen Gesundheitsämtern. Secure Instant Messaging beschreibt eine digitale, chatbasierte Kommunikationsstruktur, die es Akteur*innen im Bereich der ambulanten Primärversorgung ermöglichen könnte, sich in Echtzeit zu vernetzen und niedrigschwellig über Sektorengrenzen hinweg Informationen auszutauschen. Das als Proof-of-Concept-Studie angelegte Projekt KomPan hat in zwei deutschen Modellregionen eine solche sichere Echtzeitkommunikationsstruktur implementiert, um in der Pandemiesituation einen zusätzlichen Kommunikationsweg zwischen Sektoren des Gesundheitssystems zu schaffen und insbesondere den Austausch zwischen Hausärzt*innen und den Gesundheitsämtern zu vereinfachen. An dieser Stelle werden die Ergebnisse der qualitativen Nutzer*innenbefragung vorgestellt. Methode Beginnend mit Dezember 2020 (2. COVID-19-Welle) wurde Hausärzt*innen (n = 43) und Gesundheitsamtsmitarbeitenden (n = 10) in zwei hessischen Modellregionen die Secure Instant Messaging-App „Famedly“ der Famedly GmbH zur Verfügung gestellt. Nach einer mehrmonatigen Nutzungszeit befragten wir Projektteilnehmer*innen in leitfadengestützten Telefoninterviews zu ihren Nutzungserfahrungen mit dem Messenger. Die leitgebende Fragestellung war dabei: Wie hat sich die Kommunikation zwischen den beteiligten Akteur*innen durch Secure Instant Messaging geändert? Die Interviews wurden wörtlich transkribiert und mittels thematischer Analyse ausgewertet. Ergebnisse Es wurden Interviews mit 10 Hausärzt*innen und 2 Mitarbeiter*innen aus den Gesundheitsämtern geführt. Die Nutzung einer auf Secure Instant Messaging basierenden Kommunikationsplattformbeförderte die interkollegiale Vernetzung zwischen Hausärzt*innen während der Pandemie. Auf die Kommunikation zwischen Gesundheitsämtern und Hausärzt*innen hatte die App demgegenüber nur wenig Einfluss. Die zum Teil entgegengesetzten Erwartungen und Nutzungsweisen der beiden Nutzungsgruppen (Hausärzt*innen und Gesundheitsamtsmitarbeiter*innen) führten (neben anderen Gründen) letztlich dazu, dass die Möglichkeit zur direkten transsektoralen Kommunikation mittels Secure Instant Messaging im Untersuchungsverlauf weitestgehend ungenutzt blieb. Schlussfolgerung Insbesondere in der Pandemiesituation stellt die Etablierung von Secure-Instant-Messaging-Gruppen mit regionalem Bezug für Hausärzt*innen eine willkommene Kommunikationsmöglichkeit dar, die dazu beitragen kann, interkollegiale Vernetzung zu befördern und dadurch die fluktuierende Pandemiesituation besser zu bewältigen. Es gibt Hinweise darauf, dass die effektive Anwendung von Secure Instant Messaging für die transsektorale Kommunikation demgegenüber erst im Rahmen umfassender Digitalisierungsbemühungen institutioneller Kommunikationsstrukturen mit dem Ziel einer stärkeren Vernetzung lokaler Versorgungsakteur*innen gelingt.
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An Audit and Survey of Informal Use of Instant Messaging for Dermatology in District Hospitals in KwaZulu-Natal, South Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19127462. [PMID: 35742708 PMCID: PMC9223770 DOI: 10.3390/ijerph19127462] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 04/13/2022] [Accepted: 04/20/2022] [Indexed: 02/04/2023]
Abstract
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.
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Lam TY, Wu PI, Tang RS, Tse Y, Lau JY, Wu JC, Sung JJ. Nurse-led reinforced education by mobile messenger improves the quality of bowel preparation of colonoscopy in a population-based colorectal cancer screening program: A randomized controlled trial. Int J Nurs Stud 2022; 133:104301. [DOI: 10.1016/j.ijnurstu.2022.104301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 05/20/2022] [Accepted: 05/24/2022] [Indexed: 11/24/2022]
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Matsuo T, Hayashi K, Uehara Y, Mori N. Essential consultants' skills and attitudes (Willing CONSULT): a cross-sectional survey. BMC MEDICAL EDUCATION 2021; 21:366. [PMID: 34217282 PMCID: PMC8254944 DOI: 10.1186/s12909-021-02810-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 06/04/2021] [Indexed: 05/25/2023]
Abstract
BACKGROUND Despite multi-professional collaboration via consultation being increasingly important given the variety of disease diagnoses and treatment, the key elements as consultants remain unclear. The study aimed to identify the skills and attitudes that are important for consultants from the residents' perspective so that they can be targeted as priority goals in subsequent educational interventions. METHODS We conducted our research in two phases: a preliminary survey (May 1 to 14, 2020) and a main survey (June 1 to 14, 2020). As a preliminary survey, first-year postgraduate residents at St. Luke's International Hospital in Tokyo, Japan, were first asked an open-ended question about the types of skills and attitudes that are important for consultants. After eliminating duplicate answers, there were 19 skills and attitudes in total. In the main survey with residents who completed their residency training at our institute, from 2014 to 2018 and current residents (2019-2020), we first asked them about their demographic characteristics (gender, years of postgraduate education, and type of specialty). Then, they answered how important each skill and attitude are for consultants. All 19 items were scored on a seven-point Likert scale that ranged from 0 (completely disagree) to 6 (totally agree). Cronbach's alpha confirmed the internal consistency of the questionnaire items. Principal component analysis and exploratory factor analysis were performed. RESULTS The survey included 107 individuals (61.1 %, 175 potential participants). The median postgraduate years of education was four (interquartile range: 2-5), and 64.5 % were men (n = 69). Seven key elements for consultants were identified and termed Willing CONSULT. These included (1) willingness (willingness to accept consultation requests), (2) contact (easy access to consultants), (3) needs (consideration of consulters' needs), (4) suggestions and support (providing clear recommendations and suggestions, following up on the patients, and supporting the consulters continuously), (5) urgency (considering the situation's urgency and responding appropriately), (6) learning opportunities (providing teaching points), and (7) text (writing medical records). CONCLUSIONS We propose Willing CONSULT, which are important skills and attitudes for consultants.
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Affiliation(s)
- Takahiro Matsuo
- Department of Infectious Diseases, St. Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo, Japan.
| | - Kuniyoshi Hayashi
- Graduate School of Public Health, St. Luke's International University, Tokyo, Japan
| | - Yuki Uehara
- Department of Infectious Diseases, St. Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo, Japan
- Department of Clinical Laboratory, St. Luke's International Hospital, Tokyo, Japan
- Department of Microbiology, Juntendo University Faculty of Medicine, Tokyo, Japan
- Department of General Medicine, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Nobuyoshi Mori
- Department of Infectious Diseases, St. Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo, Japan
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Karahan I, Sengul Aycicek G. HOME-BASED PALLIATIVE CARE VIA SMARTPHONE APPLICATIONS DURING THE PANDEMIC. CENTRAL ASIAN JOURNAL OF MEDICAL HYPOTHESES AND ETHICS 2021. [DOI: 10.47316/cajmhe.2021.2.2.07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
HOME-BASED PALLIATIVE CARE VIA SMARTPHONE APPLICATIONS DURING THE PANDEMIC
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Chiang KF, Wang HH, Hsieh HF. Factors influencing the mobile instant messaging application usage behaviours among home healthcare providers. J Clin Nurs 2021; 30:3577-3589. [PMID: 34189775 DOI: 10.1111/jocn.15868] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 03/24/2021] [Accepted: 05/04/2021] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To explore the practice related to mobile instant messaging applications usage among home healthcare providers in Taiwan; and based on the unified theory of acceptance and usage of technology and perceived risk theory to examine the influencing factors. BACKGROUND Previous work has indicated the potential for using mobile instant messaging applications in chronic disease, disasters and public health emergencies. However, few studies have conducted to understand how healthcare professionals use them. DESIGN A cross-sectional design was used in the study. METHODS A wide-ranging empirical investigation was conducted in Taiwan. A total of 102 home agencies participated in this study, and 331 valid data were collected. The ODS guideline was followed. RESULTS 69% of the participants had used mobile instant messaging applications, with high functionality and interesting value can integrate various messages and contribute to adoption. Performance expectancy, effort expectancy, and social influence were significantly positively correlated with behavioral intention. The perceived risk had a significant negative correlation with performance expectancy and use behavior. Among the relevant influencing factors, different types of organization, job position, and institutional policy were related to significant differences in use behaviors. CONCLUSIONS Our research reported on mobile instant messaging applications usage and behavioral intention among home healthcare providers. This study also highlighted the need to establish regulations within the applications and improve safety and security guidelines. Further research may extend the understanding of the organizations' influencing factors. RELEVANCE TO CLINICAL PRACTICE This study may help programmers, managers and policymakers improve their strategies for expanding usage of mobile instant messaging applications.
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Affiliation(s)
- Kuei-Feng Chiang
- Tainan Sin-Lau Hospital, Tainan, Taiwan.,Chang Jung Christian University, Tainan, Taiwan
| | - Hsiu-Hung Wang
- College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hsiu-Fen Hsieh
- College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan
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Barayev E, Shental O, Yaari D, Zloczower E, Shemesh I, Shapiro M, Glassberg E, Magnezi R. WhatsApp Tele-Medicine - usage patterns and physicians views on the platform. Isr J Health Policy Res 2021; 10:34. [PMID: 34074319 PMCID: PMC8167384 DOI: 10.1186/s13584-021-00468-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 05/25/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Telemedicine has become an integral part of health care delivery in recent years. One of the leading applications for this use is WhatsApp - a free smartphone application that allows instant messaging with pictures and videos. This study analyzed the emerging role of WhatsApp on reducing the need for referrals to medical specialists and to compare the views of physicians regarding WhatsApp consultations. METHODS A cross-sectional study based on an anonymous web-survey was conducted among PCPs and medical specialists working in the Israel Defense Forces Medical-Corps during September and October, 2019. RESULTS Of 201 participants, 153 were PCPs and 48 were medical specialists. 86.9 % of PCPs and 86.5 % of specialists used WhatsApp every day in professional settings. Added workload, potential breaching of patient confidentiality and lack of full documentation of consultations were the main concerns among physicians using the application. 60.7 % of PCPs and 95.7 % of specialists stated that these consultations have reduced the need for in-person appointments at least once a week. CONCLUSIONS In times of COVID-19 that require social distancing, WhatsApp provides a simple, readily available platform for consultations between healthcare providers, even to the extent of rendering some in-person appointments unnecessary. Healthcare organizations should address the matters troubling healthcare providers, mainly patient confidentiality and lack of documentation in patients' medical records, while providing adequate compensation for those providing the service during and after work hours.
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Affiliation(s)
- Edward Barayev
- Department of Public Health and Health Systems Management Program, Bar Ilan University, 52900, Ramat Gan, Israel.
- Israel Defense Forces Medical Corps, Tel Aviv, Israel.
| | - Omri Shental
- Department of Public Health and Health Systems Management Program, Bar Ilan University, 52900, Ramat Gan, Israel
- Israel Defense Forces Medical Corps, Tel Aviv, Israel
| | - Dotan Yaari
- Department of Public Health and Health Systems Management Program, Bar Ilan University, 52900, Ramat Gan, Israel
- Israel Defense Forces Medical Corps, Tel Aviv, Israel
| | - Elchanan Zloczower
- Department of Public Health and Health Systems Management Program, Bar Ilan University, 52900, Ramat Gan, Israel
- Israel Defense Forces Medical Corps, Tel Aviv, Israel
| | - Itai Shemesh
- Department of Public Health and Health Systems Management Program, Bar Ilan University, 52900, Ramat Gan, Israel
- Israel Defense Forces Medical Corps, Tel Aviv, Israel
| | | | | | - Racheli Magnezi
- Department of Public Health and Health Systems Management Program, Bar Ilan University, 52900, Ramat Gan, Israel
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Understanding How to Improve the Use of Clinical Coordination Mechanisms between Primary and Secondary Care Doctors: Clues from Catalonia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18063224. [PMID: 33804691 PMCID: PMC8003988 DOI: 10.3390/ijerph18063224] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 03/10/2021] [Accepted: 03/11/2021] [Indexed: 01/27/2023]
Abstract
Clinical coordination between primary (PC) and secondary care (SC) is a challenge for health systems, and clinical coordination mechanisms (CCM) play an important role in the interface between care levels. It is therefore essential to understand the elements that may hinder their use. This study aims to analyze the level of use of CCM, the difficulties and factors associated with their use, and suggestions for improving clinical coordination. A cross-sectional online survey-based study using the questionnaire COORDENA-CAT was conducted with 3308 PC and SC doctors in the Catalan national health system. Descriptive bivariate analysis and logistic regression models were used. Shared Electronic Medical Records were the most frequently used CCM, especially by PC doctors, and the one that presented most difficulties in use, mostly related to technical problems. Some factors positively associated with frequent use of various CCM were: working full-time in integrated areas, or with local hospitals. Interactional and organizational factors contributed to a greater extent among SC doctors. Suggestions for improving clinical coordination were similar between care levels and related mainly to the improvement of CCM. In an era where management tools are shifting towards technology-based CCM, this study can help to design strategies to improve their effectiveness.
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Barayev E, Vorobichik Berar O, Dotan G, Skaat A, Gal-Or O, Gershoni A, Gaton D. Ophthalmologists and WhatsApp: Teleophthalmology is already here. Eur J Ophthalmol 2021; 32:688-694. [PMID: 33719643 DOI: 10.1177/11206721211002694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To estimate the extent of WhatsApp utilization using text and media messages for inter-physician consultations among ophthalmologists (residents and specialists) at various clinical settings and its perceived benefits for ophthalmologists and their patients. We also aimed to detect obstacles that concern ophthalmologists when using WhatsApp as a consultation platform. METHODS This was a cross-sectional study using a self-administered survey through Google Forms, which was sent to 660 practicing ophthalmologists during April to May 2020. RESULTS One hundred and ninety-two ophthalmologists completed the questionnaire, 151 of which (78.6%) were specialists and 41 (21.4%) were residents. Most ophthalmologists reported using WhatsApp at least once a day for both personal and professional use. Residents reported lower rates of contacting patients using WhatsApp than specialists (1.51 ± 0.98 vs 2.72 ± 1.32, p < 0.001). Respondents reported WhatsApp consultations frequently replaced referrals of patients to other physicians, with a median of once a week. 97.8% of residents and 91.4% of specialists reported the ability to share media is a major advantage of WhatsApp over other medias, followed by rapid responses for consultations. CONCLUSION Many ophthalmologists already use WhatsApp as a tool for professional consultations with other providers, mainly thanks to its simplicity and wide availability. Residents use it more frequently than specialists, and ranked it higher when asked how much WhatsApp has improved the clinical setting. Policy makers should address concerns brought up by physicians, such as documentation in medical records and proper compensation for consulting ophthalmologists during and after work hours.
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Affiliation(s)
- Edward Barayev
- Department of Ophthalmology, Rabin Medical Center and Schneider Hospital, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ofri Vorobichik Berar
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Goldschleger Eye Institute, Sheba Medical Center, Ramat Gan, Israel
| | - Gad Dotan
- Department of Ophthalmology, Rabin Medical Center and Schneider Hospital, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Alon Skaat
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Goldschleger Eye Institute, Sheba Medical Center, Ramat Gan, Israel
| | - Orly Gal-Or
- Department of Ophthalmology, Rabin Medical Center and Schneider Hospital, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Assaf Gershoni
- Department of Ophthalmology, Rabin Medical Center and Schneider Hospital, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dan Gaton
- Department of Ophthalmology, Rabin Medical Center and Schneider Hospital, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Scott RE, Morris C, Mars M. Development of a "Cellphone Stewardship Framework": Legal, Regulatory, and Ethical Issues. Telemed J E Health 2021; 27:316-322. [PMID: 32460692 PMCID: PMC7958990 DOI: 10.1089/tmj.2020.0048] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 03/24/2020] [Accepted: 03/24/2020] [Indexed: 10/24/2022] Open
Abstract
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.
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Affiliation(s)
- Richard E. Scott
- Department of Telehealth, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
- Department of Community Health Sciences, University of Calgary, Calgary, Canada
- NT Consulting–Global e-Health, Inc., Calgary, Canada
| | - Christopher Morris
- Department of Telehealth, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Maurice Mars
- Department of Telehealth, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
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15
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Karaismailoğlu B, Erkuş S, Bacaksız T, Ercan N, Kendirci AŞ, Küçükdurmaz F, Kalenderer Ö, Öztürk İ. Instant messaging application usage for clinical consultation among orthopedic surgery residents in Turkey: A survey study. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2021; 55:5-8. [PMID: 33650503 DOI: 10.5152/j.aott.2021.20041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This study aimed to determine the characteristics of instant messaging application (IMA) usage for clinical consultation among orthopedic residents in Turkey and to explore their experiences and opinions concerning potential legal problems. METHODS A questionnaire titled "Instant messaging for consultation among orthopedic surgeons" consisting of 21 questions was applied to orthopedic surgery residents, and the results were analyzed. The questions were designed to obtain information on 4 categories: 1) demographics and professional experience, 2) attitudes on the use of cellular phones, 3) IMA usage for clinical consultation purposes, and 4) problems and comments on smartphone application usage for clinical consultation purposes. The participants who had no experience with a smartphone or IMA usage were excluded at the final analysis. RESULTS A total of 860 orthopedic residents (849 males [98.7%]; mean age=28.6 years; age range=22-44 years) participated in the survey (participation rate: 97.3%). The distribution of residency years was as follows: 1st year, 27%; 2nd year, 21.4%; 3rd year, 18.4%; 4th year, 17.4%; and 5th year, 49.9%. The most frequently used IMAs were WhatsApp (99.3%), Facebook Messenger (14.8%), Viber (8%), and Tango (1.3%). The rate of IMA usage for consultation was 95.3%. The most common reasons to prefer IMAs for consultation were being "fast" and "easy," but only 26.3% of the residents reported that they prefer the use of IMAs because they find them "reliable." Moreover, 41.7% of the respondents reported that they had an experience of misdiagnosis owing to the use of IMAs; 81.2% of the participants used the personal information of the patients during the consultation; 57.6% of the respondents considered that legal problems may arise because of the use of IMAs during the consultation; and 51.4% believed that an electronic platform, solely for consultation purposes, is required. CONCLUSION This survey has shown that it is necessary to make some legal regulations regarding the use of IMAs for consultation purposes and to develop applications only for medical consultation purposes. Most of the trainees make decisions using IMAs without a proper examination, putting the patients at the risk of misdiagnosis. Moreover, the confidentiality of the patient's personal information appears to be in danger when IMAs are used. LEVEL OF EVIDENCE Level IV, Diagnostic Study.
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Affiliation(s)
| | - Serkan Erkuş
- Department of Orthopaedics and Traumatology, Tepecik Training and Research Hospital, İzmir, Turkey
| | - Tayfun Bacaksız
- Clinic of Orthopaedics and Traumatology, Akçakale State Hospital, Şanlıurfa, Turkey
| | - Niyazi Ercan
- Department of Orthopaedics and Traumatology, Ankara Training and Research Hospital, Ankara, Turkey
| | - Alper Şükrü Kendirci
- Department of Orthopaedics and Traumatology, İstanbul University, İstanbul School of Medicine, İstanbul, Turkey
| | - Fatih Küçükdurmaz
- Department of Orthopaedics and Traumatology, Marmara University, School of Medicine, İstanbul, Turkey
| | - Önder Kalenderer
- Department of Orthopaedics and Traumatology, Tepecik Training and Research Hospital, İzmir, Turkey
| | - İrfan Öztürk
- Department of Orthopaedics and Traumatology, İstanbul University, İstanbul School of Medicine, İstanbul, Turkey
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16
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Sabırlı R, Karsli E, Canacik O, Ercin D, Çiftçi H, Sahin L, Dolanbay T, Tutuncu EE. Use of WhatsApp for Polyclinic Consultation of Suspected Patients With COVID-19: Retrospective Case Control Study. JMIR Mhealth Uhealth 2020; 8:e22874. [PMID: 33276318 PMCID: PMC7735810 DOI: 10.2196/22874] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 10/13/2020] [Accepted: 12/03/2020] [Indexed: 12/02/2022] Open
Abstract
Background Telephones, internet-connected devices (phablets, personal computers), chat platforms, and mobile apps (eg, Skype, Facebook Messenger, WhatsApp) can be exploited for telemedicine applications. WhatsApp and similar apps are also widely used to facilitate clinical communication between physicians. Moreover, WhatsApp is used by emergency department (ED) physicians and consulting physicians to exchange medical information during ED consultations. This platform is regarded as a useful app in the consultation of dermatological and orthopedic cases. Preventing overcrowding in the ED is key to reducing the risk of disease transmission, and teleconsulting practice is thought to be effective in the diagnosis, treatment, and reduction of transmission risk of disease, most notably during the COVID-19 pandemic. Video consultation is highly recommended in some countries on the grounds that it is likely to reduce the risk of transmission. WhatsApp-like apps are among the video consultation platforms that are assumed to reduce the risk of contamination by minimizing patient-physician contact. Objective The aim of this study was to investigate the effects of WhatsApp video consultation on patient admission and discharge times in comparison to bedside consultation in the evaluation of potential patients with COVID-19 visiting a COVID-19 outpatient clinic during the pandemic. Methods Patients who presented to the ED COVID-19 outpatient clinic between March 11 and May 31, 2020, and for whom an infectious disease specialist was consulted (via WhatsApp or at bedside) were included in the study in accordance with the inclusion and exclusion criteria. Eventually, 54 patients whose consultations were performed via WhatsApp and 90 patients whose consultations were performed at bedside were included in our study. Results The median length of stay in the ED of discharged patients amounted to 103 minutes (IQR 85-147.75) in the WhatsApp group and 196 minutes (IQR 141-215) in the bedside group. In this regard, the length of stay in the ED was found to be significantly shorter in the WhatsApp group than in the bedside group (P<.001). Among the consulted and discharged patients, 1 patient in each group tested positive for SARS-CoV-2 by polymerase chain reaction test and thus was readmitted and hospitalized (P=.62). The median length of stay of the inpatients in the ED was found to be 116.5 minutes (IQR 85.5-145.5) in the WhatsApp group and 132 minutes (IQR 102-168) in the bedside group. The statistical analysis of this time difference revealed that the length of stay in the ED was significantly shorter for patients in the WhatsApp group than in the bedside group (P=.04). Conclusions Consultation via WhatsApp reduces both contact time with patients with COVID-19 and the number of medical staff contacting the patients, which contributes greatly to reducing the risk of COVID-19 transmission. WhatsApp consultation may prove useful in clinical decision making as well as in shortening process times. Moreover, it does not result in a decreased accuracy rate. The shortened discharge and hospitalization timespans also decreased the length of stay in the ED, which can have an impact on minimizing ED crowding. Trial Registration ClinicalTrials.gov NCT04645563; https://clinicaltrials.gov/ct2/show/NCT04645563.
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Affiliation(s)
- Ramazan Sabırlı
- Kafkas University Faculty of Medicine, Department of Emergency Medicine, Kars, Turkey
| | - Emre Karsli
- Kafkas University Faculty of Medicine, Department of Emergency Medicine, Kars, Turkey
| | - Omer Canacik
- Kafkas University Faculty of Medicine, Department of Emergency Medicine, Kars, Turkey
| | - Dogan Ercin
- Kafkas University Faculty of Medicine, Department of Emergency Medicine, Kars, Turkey
| | - Handan Çiftçi
- Kafkas University Faculty of Medicine, Department of Emergency Medicine, Kars, Turkey
| | - Levent Sahin
- Kafkas University Faculty of Medicine, Department of Emergency Medicine, Kars, Turkey
| | - Turgut Dolanbay
- Kafkas University Faculty of Medicine, Department of Emergency Medicine, Kars, Turkey
| | - Emin Ediz Tutuncu
- Kafkas University Faculty of Medicine, Department of Infectious Diseases, Kars, Turkey
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17
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Lee MS, Nambudiri VE. Electronic Consultations (eConsults) for Safe and Equitable Coordination of Virtual Outpatient Specialty Care. Appl Clin Inform 2020; 11:821-824. [PMID: 33296918 DOI: 10.1055/s-0040-1719181] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Affiliation(s)
- Michelle S Lee
- Department of Dermatology, Harvard Medical School, Boston, Massachusetts, United States.,Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts, United States
| | - Vinod E Nambudiri
- Department of Dermatology, Harvard Medical School, Boston, Massachusetts, United States.,Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts, United States
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18
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Lam TYT, Wu PI, Tang RSY, Luk AKC, Ng S, Sung JJY. Mobile messenger-initiated reminders improve longitudinal adherence in a community-based, opportunistic colorectal cancer screening program: A single-blind, crossover randomized controlled study. Cancer 2020; 127:914-921. [PMID: 33216357 DOI: 10.1002/cncr.33336] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 10/23/2020] [Accepted: 10/29/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND The fecal immunochemical test (FIT) is a cost-effective colorectal cancer (CRC) screening tool. However, longitudinal adherence, a factor that is critical to the success to any FIT-based screening program, often is poor. The authors hypothesized that reminders sent via mobile messengers, such as WhatsApp, improve such adherence. METHODS In the current single-blind, randomized study, subjects from an opportunistic FIT screening program who had a negative FIT result the year prior were randomly allocated (1:1) to receive either a 1-off reminder via the WhatsApp messenger (WR) 1 month prior to the due appointments or no reminder (NR). All subjects were blinded to study participation and group allocation. At 24 months after randomization, a crossover of intervention was performed among those individuals who remained in the FIT program. The primary outcome was FIT adherence, defined as the pick-up and on-time return of the FIT. The secondary outcome was FIT adherence after the crossover. RESULTS A total of 500 subjects were randomized to receive WR (250 subjects) or NR (250 subjects). Three individuals were excluded from analysis (1 died and 2 underwent colonoscopy). Both the FIT pick-up rate (80.3% vs 59.3%; P < .001) and return rate (79.9% vs 57.3%; P < .001) were significantly higher in the WR group compared with the NR group. After crossover of intervention (452 subjects), the WR group again was found to have a higher FIT pick-up rate (79.1% vs 52.9%; P < .001) and return rate (78.2% vs 52.4%; P < .001). CONCLUSIONS Text reminders sent via mobile messenger appear to improve the longitudinal adherence to FIT-based opportunistic CRC screening programs. The routine use of this technology in CRC screening should be considered.
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Affiliation(s)
- Thomas Y T Lam
- Institute of Digestive Disease, Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Peter I Wu
- Institute of Digestive Disease, Chinese University of Hong Kong, Hong Kong, Hong Kong.,Department of Gastroenterology and Hepatology, St. George Hospital, University of New South Wales, Sydney, New South Wales, Australia
| | - Raymond S Y Tang
- Institute of Digestive Disease, Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Arthur K C Luk
- Institute of Digestive Disease, Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Simpson Ng
- Institute of Digestive Disease, Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Joseph J Y Sung
- Institute of Digestive Disease, Chinese University of Hong Kong, Hong Kong, Hong Kong
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19
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Evaluation of a Managed Surgical Consultation Network in Malawi. World J Surg 2020; 45:356-361. [PMID: 33026475 DOI: 10.1007/s00268-020-05809-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Access to surgery is a challenge for low-income countries like Malawi due to shortages of specialists, especially in rural areas. District hospitals (DH) cater for the immediate surgical needs of rural patients, sending difficult cases to central hospitals (CH), usually with no prior communication. METHODS In 2018, a secure surgical managed consultation network (MCN) was established to improve communication between specialist surgeons and anaesthetists at Queen Elizabeth and Zomba Central Hospitals, and surgical providers from nine DHs referring to these facilities. RESULTS From May to December 2018, DHs requested specialist advice on 249 surgical cases through the MCN, including anonymised images (52% of cases). Ninety six percent of cases received advice, with a median of two specialists answering. For 74% of cases, a first response was received within an hour, and in 68% of the cases, a decision was taken within an hour from posting the case on MCN. In 60% of the cases, the advice was to refer immediately, in 26% not to refer and 11% to possibly refer at a later stage. CONCLUSION The MCN facilitated quick access to consultations with specialists on how to manage surgical patients in remote rural areas. It also helped to prevent unnecessary referrals, saving costs for patients, their guardians, referring hospitals and the health system as a whole. With time, the network has had spillover benefits, allowing the Ministry of Health closer monitoring of surgical activities in the districts and to respond faster to shortages of essential surgical resources.
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20
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Gonçalves-Bradley DC, J Maria AR, Ricci-Cabello I, Villanueva G, Fønhus MS, Glenton C, Lewin S, Henschke N, Buckley BS, Mehl GL, Tamrat T, Shepperd S. Mobile technologies to support healthcare provider to healthcare provider communication and management of care. Cochrane Database Syst Rev 2020; 8:CD012927. [PMID: 32813281 PMCID: PMC7437392 DOI: 10.1002/14651858.cd012927.pub2] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND The widespread use of mobile technologies can potentially expand the use of telemedicine approaches to facilitate communication between healthcare providers, this might increase access to specialist advice and improve patient health outcomes. OBJECTIVES To assess the effects of mobile technologies versus usual care for supporting communication and consultations between healthcare providers on healthcare providers' performance, acceptability and satisfaction, healthcare use, patient health outcomes, acceptability and satisfaction, costs, and technical difficulties. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase and three other databases from 1 January 2000 to 22 July 2019. We searched clinical trials registries, checked references of relevant systematic reviews and included studies, and contacted topic experts. SELECTION CRITERIA Randomised trials comparing mobile technologies to support healthcare provider to healthcare provider communication and consultations compared with usual care. DATA COLLECTION AND ANALYSIS We followed standard methodological procedures expected by Cochrane and EPOC. We used the GRADE approach to assess the certainty of the evidence. MAIN RESULTS We included 19 trials (5766 participants when reported), most were conducted in high-income countries. The most frequently used mobile technology was a mobile phone, often accompanied by training if it was used to transfer digital images. Trials recruited participants with different conditions, and interventions varied in delivery, components, and frequency of contact. We judged most trials to have high risk of performance bias, and approximately half had a high risk of detection, attrition, and reporting biases. Two studies reported data on technical problems, reporting few difficulties. Mobile technologies used by primary care providers to consult with hospital specialists We assessed the certainty of evidence for this group of trials as moderate to low. Mobile technologies: - probably make little or no difference to primary care providers following guidelines for people with chronic kidney disease (CKD; 1 trial, 47 general practices, 3004 participants); - probably reduce the time between presentation and management of individuals with skin conditions, people with symptoms requiring an ultrasound, or being referred for an appointment with a specialist after attending primary care (4 trials, 656 participants); - may reduce referrals and clinic visits among people with some skin conditions, and increase the likelihood of receiving retinopathy screening among people with diabetes, or an ultrasound in those referred with symptoms (9 trials, 4810 participants when reported); - probably make little or no difference to patient-reported quality of life and health-related quality of life (2 trials, 622 participants) or to clinician-assessed clinical recovery (2 trials, 769 participants) among individuals with skin conditions; - may make little or no difference to healthcare provider (2 trials, 378 participants) or participant acceptability and satisfaction (4 trials, 972 participants) when primary care providers consult with dermatologists; - may make little or no difference for total or expected costs per participant for adults with some skin conditions or CKD (6 trials, 5423 participants). Mobile technologies used by emergency physicians to consult with hospital specialists about people attending the emergency department We assessed the certainty of evidence for this group of trials as moderate. Mobile technologies: - probably slightly reduce the consultation time between emergency physicians and hospital specialists (median difference -12 minutes, 95% CI -19 to -7; 1 trial, 345 participants); - probably reduce participants' length of stay in the emergency department by a few minutes (median difference -30 minutes, 95% CI -37 to -25; 1 trial, 345 participants). We did not identify trials that reported on providers' adherence, participants' health status and well-being, healthcare provider and participant acceptability and satisfaction, or costs. Mobile technologies used by community health workers or home-care workers to consult with clinic staff We assessed the certainty of evidence for this group of trials as moderate to low. Mobile technologies: - probably make little or no difference in the number of outpatient clinic and community nurse consultations for participants with diabetes or older individuals treated with home enteral nutrition (2 trials, 370 participants) or hospitalisation of older individuals treated with home enteral nutrition (1 trial, 188 participants); - may lead to little or no difference in mortality among people living with HIV (RR 0.82, 95% CI 0.55 to 1.22) or diabetes (RR 0.94, 95% CI 0.28 to 3.12) (2 trials, 1152 participants); - may make little or no difference to participants' disease activity or health-related quality of life in participants with rheumatoid arthritis (1 trial, 85 participants); - probably make little or no difference for participant acceptability and satisfaction for participants with diabetes and participants with rheumatoid arthritis (2 trials, 178 participants). We did not identify any trials that reported on providers' adherence, time between presentation and management, healthcare provider acceptability and satisfaction, or costs. AUTHORS' CONCLUSIONS Our confidence in the effect estimates is limited. Interventions including a mobile technology component to support healthcare provider to healthcare provider communication and management of care may reduce the time between presentation and management of the health condition when primary care providers or emergency physicians use them to consult with specialists, and may increase the likelihood of receiving a clinical examination among participants with diabetes and those who required an ultrasound. They may decrease the number of people attending primary care who are referred to secondary or tertiary care in some conditions, such as some skin conditions and CKD. There was little evidence of effects on participants' health status and well-being, satisfaction, or costs.
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Affiliation(s)
| | - Ana Rita J Maria
- Nova Medical School, Faculdade de Ciências Médicas, Lisbon, Portugal
| | - Ignacio Ricci-Cabello
- Primary Care Research Unit, Instituto de Investigación Sanitaria Illes Balears, Palma de Mallorca, Spain
| | | | | | | | - Simon Lewin
- Norwegian Institute of Public Health, Oslo, Norway
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | | | - Brian S Buckley
- Department of Surgery, University of the Philippines, Manila, Philippines
| | - Garrett L Mehl
- Department of Sexual and Reproductive Health, World Health Organization, Geneva, Switzerland
| | - Tigest Tamrat
- Department of Sexual and Reproductive Health, World Health Organization, Geneva, Switzerland
| | - Sasha Shepperd
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
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21
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Mars M, Morris C, Scott RE. WhatsApp guidelines - what guidelines? A literature review. J Telemed Telecare 2020; 25:524-529. [PMID: 31631763 DOI: 10.1177/1357633x19873233] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
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.
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Affiliation(s)
- Maurice Mars
- Department of TeleHealth, College of Health Sciences, University of KwaZulu-Natal, South Africa
| | - Christopher Morris
- Department of TeleHealth, College of Health Sciences, University of KwaZulu-Natal, South Africa
| | - Richard E Scott
- Department of TeleHealth, College of Health Sciences, University of KwaZulu-Natal, South Africa.,Department of Community Health Sciences, University of Calgary, Canada; NT Consulting - Global e-Health Inc., Calgary, Canada
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22
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do Nascimento IJB, Oliveira JADQ, Wolff IS, Ribeiro LD, Souza e Silva MVR, Cardoso CS, Mars M, Ribeiro AL, Marcolino MS. Use of smartphone-based instant messaging services in medical practice: a cross-sectional study. SAO PAULO MED J 2020; 138:86-92. [PMID: 32321110 PMCID: PMC9673850 DOI: 10.1590/1516-3180.2020.0010.r1.28032020] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 03/28/2020] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Instant messaging services (IMS) are widely used in medical practice. OBJECTIVE To evaluate perceptions regarding use and usability of IMS within clinical practice and assess users' knowledge of the ethical and legal context involved in using IMS within medical practice. DESIGN AND SETTING Cross-sectional study conducted in different hospitals and medical institutions in Minas Gerais, Brazil. METHODS Medical students, medical residents, primary care physicians and specialist doctors answered an online questionnaire regarding epidemiological data, graduation level and use of IMS for medical communication. Responses were collected over a five-month period and data were assessed using the IBM-SPSS software. RESULTS 484 people answered the questionnaire: 97.0% declared that they were using IMS for medical-related purposes; 42.0%, to elucidate medical concerns every week; 75.0%, to share imaging or laboratory tests and patients' medical records; and 90.5%, to participate in clinical case-study private groups. Moreover, only 37.0% declared that they had knowledge of the legislative aspects of use of smartphones within clinical practice. Differences in the frequency of discussion of medical concerns within the daily routine between student/residents and general practitioners/specialists, and in the frequency of image-sharing and patient-guiding/assistance between students and medical doctors, were observed. CONCLUSIONS Our results provide reliable proof that medical doctors and students use IMS, as a tool for clinical case discussions, interactions between healthcare providers and patients, or dissemination of knowledge and information. Nonetheless, because of limitations to the ethical and legal regulations, evidence-based discussions between authorities, academics and medical institutions are needed in order to fully achieve positive outcomes from such platforms.
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Affiliation(s)
- Israel Junior Borges do Nascimento
- PharmB. Medical Research Specialist, Medical School and TeleHealth Center, University Hospital, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte (MG), Brazil; and Medical Research Specialist, Medical College of Wisconsin, Milwaukee, Wisconsin, United States.
| | - João Antonio de Queiroz Oliveira
- PharmD. MSc. Pharmacist, Medical School and TeleHealth Center, University Hospital, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte (MG), Brazil
| | - Iago Souza Wolff
- MD. Physician, Medical School and TeleHealth Center, University Hospital, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte (MG), Brazil.
| | - Laura Defensor Ribeiro
- MD. Physician, Medical School and TeleHealth Center, University Hospital, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte (MG), Brazil.
| | - Maíra Viana Rego Souza e Silva
- MD. Physician, Medical School and TeleHealth Center, University Hospital, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte (MG), Brazil.
| | - Clareci Silva Cardoso
- MD, MSc, PhD. Professor, Department of Public Health, Medical School and TeleHealth Center, Universidade Federal de São João del-Rei, Divinópolis, Brazil.
| | - Maurice Mars
- MBChB, MD. Professor, Department of TeleHealth, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa.
| | - Antonio Luiz Ribeiro
- MD, PhD. Professor, Medical School and TeleHealth Center, University Hospital, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte (MG), Brazil.
| | - Milena Soriano Marcolino
- MD, MSc, PhD. Professor, Medical School and TeleHealth Center, University Hospital, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte (MG), Brazil.
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23
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Feinberg J, Shaw S, Kashyap N, Illuzzi J, Campbell K, Hsiao AL, Pettker CM. Evaluating the Impact of a New Smartphone Texting Tool on Patient Care in Obstetrics, an Emergent Healthcare Setting. Appl Clin Inform 2019; 10:879-887. [PMID: 31747710 DOI: 10.1055/s-0039-1700868] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Hospitals across the country are investing millions of dollars to adopt new Health Insurance Portability and Accountability Act (HIPAA)-compliant secure text messaging systems. However, in nearly all cases, these implementations are occurring without evaluation of their impact on patient care. OBJECTIVE To evaluate perceived impact on patient care and workflow of new text messaging system implemented in obstetrics at Yale-New Haven Hospital and to inform guidelines for future implementations in emergent settings. METHODS A new HIPAA-compliant texting system was implemented in obstetrics in 2016. Before implementation of the new system, residents and nurses were surveyed on perceived effect of communication system (pagers with text receiving, service mobile phones, personal cell phones) on clinical workflow and patient care using 5-point Likert scale and open-ended questions. Following roll-out (1 and 6 months), both teams were surveyed with same questions. Results were compared using Wilcoxon-Mann-Whitney test (0-1 months and then 0-6 months). Open-ended question results were qualitatively compared for recurrent unifying themes. RESULTS In both nursing and resident domains, 1 month after implementation, the new communication system was perceived to significantly improve efficiency and patient care across all metrics. After 6 months, this effect decayed in nearly all categories (including efficiency, real-time communication, and knowledge of covering provider). The exception was nurse's knowledge of which resident to contact and resident's timely evaluation of patient, for which we observed sustained improvements. System shortcomings identified included interrupted connection (i.e., dropped calls), dysfunctional and inaccurate alert system, and unclear identification of the covering provider. CONCLUSION A new text-messaging-based communication system may improve efficiency and patient care in emergent settings, but system shortcomings can substantially erode potential benefits over time. We recommend implementers evaluate new systems for a set of specific functional requirements to increase probability of sustained improvement and decrease risk of poor patient outcomes.
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Affiliation(s)
- Jacqueline Feinberg
- Department of Obstetrics and Gynecology, Yale School of Medicine, New Haven, Connecticut, United States
| | - Sara Shaw
- Yale New Haven Hospital, New Haven, Connecticut, United States
| | - Nitu Kashyap
- Department of Obstetrics and Gynecology, Yale School of Medicine, New Haven, Connecticut, United States
| | - Jessica Illuzzi
- Department of Obstetrics and Gynecology, Yale School of Medicine, New Haven, Connecticut, United States
| | - Katherine Campbell
- Department of Obstetrics and Gynecology, Yale School of Medicine, New Haven, Connecticut, United States
| | - Allen L Hsiao
- Department of Obstetrics and Gynecology, Yale School of Medicine, New Haven, Connecticut, United States
| | - Christian M Pettker
- Department of Obstetrics and Gynecology, Yale School of Medicine, New Haven, Connecticut, United States
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Koparal M, Ünsal HY, Alan H, Üçkardeş F, Gülsün B. WhatsApp messaging improves communication in an oral and maxillofacial surgery team. Int J Med Inform 2019; 132:103987. [PMID: 31634821 DOI: 10.1016/j.ijmedinf.2019.103987] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 08/16/2019] [Accepted: 09/30/2019] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Smartphones have become very popular among oral and maxillofacial surgeons. WhatsApp is an application that enables users to send voice, text, and multimedia messages using the group communication feature. The purpose of this study was to evaluate the efficiency of WhatsApp messaging as a mode of consultation within an oral and maxillofacial surgery team. MATERIALS AND METHODS A retrospective study on WhatsApp group conversations amongst oral and maxillofacial surgeons was performed between July 2015 and July 2016. A WhatsApp group consisting of senior and junior surgeons was created, and many consultations were recorded. Seven hundred fifty-six consultations were included in the study. In this study, the arrival and response times of messages, types of cases, timing of consultation's end, consultant locations, contents of multimedia messages, and the categories/types of messages were evaluated. During consultations, some cases were discussed with text messages via WhatsApp, and some cases with voice and image messages via WhatsApp, with or without WhatsApp text messages. In addition, several cases were discussed with video messages via WhatsApp. Thus, a total of 1747 messages reflecting four different message types were included in this study: 754 (43%) were text messages, 752 (43%) were photographic images, 213 (12%) were videos, and 28 (nearly 2%) were voice messages. RESULTS The most frequent consultations concerned impacted teeth (n = 363, 48.01%). Most consultations were resolved using WhatsApp (n = 306, 64.4%), and consultants were often not in the hospital during these consultations (n = 411, 54.3%). Most messages sent by consultants were conclusive (n = 306, 74.4%). CONCLUSION We conclude that WhatsApp is a simple, free, and practical application, which allows efficient consultation when consultants are not in the hospital.
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Affiliation(s)
- Mahmut Koparal
- Adiyaman University, Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Adiyaman, 02200, Turkey.
| | | | - Hilal Alan
- Inonu University, Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Malatya, 44280, Turkey
| | - Fatih Üçkardeş
- Department of Biostatistics, Faculty of Medicine, Adiyaman University, Adiyaman 02040, Turkey
| | - Belgin Gülsün
- Dicle University, Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Diyarbakir, 21830, Turkey
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25
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Liu X, Sutton PR, McKenna R, Sinanan MN, Fellner BJ, Leu MG, Ewell C. Evaluation of Secure Messaging Applications for a Health Care System: A Case Study. Appl Clin Inform 2019; 10:140-150. [PMID: 30812040 PMCID: PMC6393161 DOI: 10.1055/s-0039-1678607] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 01/04/2019] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE The use of text messaging in clinical care has become ubiquitous. Due to security and privacy concerns, many hospital systems are evaluating secure text messaging applications. This paper highlights our evaluation process, and offers an overview of secure messaging functionalities, as well as a framework for how to evaluate such applications. METHODS Application functionalities were gathered through literature review, Web sites, speaking with representatives, demonstrations, and use cases. Based on similar levels of functionalities, vendors were grouped into three tiers. Essential and secondary functionalities for our health system were defined to help narrow our vendor choices. RESULTS We stratified 19 secure messaging vendors into three tiers: basic secure communication, secure communication within an existing clinical application, and dedicated communication and collaboration systems. Our essential requirements revolved around functionalities to enhance security and communication, while advanced functionalities were mostly considered secondary. We then narrowed our list of 19 vendors to four, then created clinical use cases to rank the final vendors. DISCUSSION When evaluating a secure messaging application, numerous factors must be considered in parallel. These include: what clinical processes to improve, archiving text messages, mobile device management, bring your own device policy, and Wi-Fi architecture. CONCLUSION Secure messaging applications provide a Health Insurance Portability and Accountability Act (HIPAA) compliant communication platform, and also include functionality to improve clinical collaboration and workflow. We hope that our evaluation framework can be used by other health systems to find a secure messaging application that meets their needs.
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Affiliation(s)
- Xinran Liu
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, Washington, United States
- Department of Internal Medicine, University of Washington, Seattle, Washington, United States
- University of Washington Information Technology Services, Seattle, Washington, United States
| | - Paul R. Sutton
- Department of Internal Medicine, University of Washington, Seattle, Washington, United States
- University of Washington Information Technology Services, Seattle, Washington, United States
| | - Rory McKenna
- Department of Telecommunications, University of Washington, Seattle, Washington, United States
| | - Mika N. Sinanan
- Department of Surgery, University of Washington, Seattle, Washington, United States
| | - B. Jane Fellner
- University of Washington Information Technology Services, Seattle, Washington, United States
- Department of Family Medicine, University of Washington, Seattle, Washington, United States
| | - Michael G. Leu
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, Washington, United States
- University of Washington Information Technology Services, Seattle, Washington, United States
- Department of Pediatrics, University of Washington, Seattle, Washington, United States
| | - Cris Ewell
- University of Washington Information Technology Services, Seattle, Washington, United States
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Calleja-Castillo JM, Gonzalez-Calderon G. WhatsApp in Stroke Systems: Current Use and Regulatory Concerns. Front Neurol 2018; 9:388. [PMID: 29904369 PMCID: PMC5991007 DOI: 10.3389/fneur.2018.00388] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 05/14/2018] [Indexed: 11/29/2022] Open
Abstract
Smartphone use is extremely common. Applications such as WhatsApp have billions of users and physicians are no exception. Stroke Medicine is a field where instant communication among fairly large groups is essential. In developing countries, economic limitations preclude the possibility of acquiring proper communication platforms. Thus, WhatsApp has been used as an organizational tool, for sharing clinical data, and for real time guidance of clinical care decisions. It has evolved into a cheap, accessible tool for telemedicine. Nevertheless, regulatory and privacy issues must be addressed. Some countries have implemented legislation to address this issue, while others lag behind. In this article, we present an overview on the different roles WhatsApp has acquired as a clinical tool in stroke systems and the potential privacy concerns of its use.
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Affiliation(s)
| | - Gina Gonzalez-Calderon
- Medicine, Instituto Tecnológico y de Estudios Superiores de Monterrey, Monterrey, Mexico
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