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WhatsApp Telemedicine For the Developing World: What Can We Learn From India by Maurice Mars Head

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WhatsApp Telemedicine For the Developing World: What Can We Learn From India by Maurice Mars Head Dept of TeleHealth, Nelson, R Mandela School of Medicine @ University of KwaZulu-Natal, South Africa

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WhatsApp Telemedicine For the Developing World: What Can We Learn From India by Maurice Mars Head

  1. 1. 1 WhatsApp Telemedicine In The Developing World: What Can We Learn From India? Maurice Mars and Richard Scott Dept of TeleHealth Nelson R Mandela School of Medicine University of KwaZulu-Natal, South Africa
  2. 2. 2 Dermatology Burns Ophthalmology ECG Radiology ICU Surgery Psychiatry Orthopaedics ENT Spontaneous Services
  3. 3. 3 Proprietary, free, instant messaging app Works across operating systems Allows text, image, video and audio messages One to one communication or One to many “group” chats 1,000,000,000 users (Feb 2016)
  4. 4. 4 Spontaneous mDermatology 2013 WhatsApp
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  10. 10. 10 Searched 5 Databases up to 31 December 2015 Inclusion criteria - use of WhatsApp • in clinical services • paper or abstract in English • peer reviewed paper or abstract Exclusion - use of WhatsApp • for education • lifestyle management Narrative Scoping Literature Review
  11. 11. 11 PubMed - “WhatsApp”[All Fields] Science Direct – WhatsApp Scopus - WhatsApp (All Fields) IEE Explore - WhatsApp Google Scholar (first 100) WhatsApp AND Telemedicine WhatsApp AND mHealth WhatsApp AND TeleHealth Search Strategy
  12. 12. 12 Search Results 357 Papers 58 Relevant 32 Included
  13. 13. 13 Full papers 13 Letters 8 Case reports 7 Abstracts 4 32 Papers
  14. 14. 14 India 12 UK 5 Saudi Arabia 3 Italy 4 Turkey 2 Spain 2 Brazil 1 Netherlands 1 Philippines 1 USA/RSA 1 10 Countries
  15. 15. 15 Orthopaedics 4 Maxillofacial 2 Plastics 1 Palliative care 1 Lab services 1 Stroke 1 Critical care 1 Diabetic retinopathy screening 1 India – 8 Disciplines
  16. 16. 16 Orthopaedics 1 Maxillofacial 1 Plastics 0 Palliative care 1 Lab services 0 Stroke 1 Critical care 1 Diabetic retinopathy screening 0 India – Case reports = 5
  17. 17. 17 WhatsApp Groups = 6 Intradepartmental Admission assessment Advice from seniors Daily status updates Administration Education Flattened hierarchy ↑ communication Improved handovers Improved records Data at hand ↓ Registrar autonomy
  18. 18. 18 Patient and Family Pin tract management Palliative care
  19. 19. 19 Taking photos and sharing with group 2 Taking photos 3 Transmission by phone 0 Storage on phone 0 Record keeping 0 Consent – 5
  20. 20. 20 Minimise mention of identifiers 2 Ward & bed number and procedure 2 Protocol HIPAA compliant 1 “Ensure patient confidentiality” 1 Only shared with group 2 Consent implies confidentiality 1 Confidentiality - 8
  21. 21. 21 “There are no clear guidelines for patient confidentiality from both the Dental Council and Medical Council of India currently and as such is less of an issue in India as compared to the developed countries.” Pandian 2014 Confidentiality
  22. 22. 22 Security - 2 Password Protected Phone WhatsApp
  23. 23. 23 Data Security
  24. 24. 24 End to End Encryption? WhatsApp Server √√ Android One to one text
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  26. 26. 26 WhatsApp messages and calls between a sender and receiver that use WhatsApp client software released after March 31, 2016 are end-to-end encrypted
  27. 27. 27
  28. 28. 28 Implied – not stated “no longer lose X-Rays” BUT Can email chats No mention of this KZ-N Burns – enter data Record Keeping
  29. 29. 29 More input on patient management Better communication Better than pager Flattening hierarchy Simple, effective, cheap Upside
  30. 30. 30 Frequent interruptions Disparity on urgency ↓ Verbal communication Online 24 h Can’t print record Not in medical record Identifying patients difficult Downside
  31. 31. 31 Little research published Wide range of disciplines Chat groups Patients and family can send Business plans ? Legal and ethical ? What Have We Learned ?
  32. 32. 32 Legal and Regulatory issues Confidentiality Encryption Data security Data storage Record keeping Evidence of consent Prescription WhatsApp Service Concerns
  33. 33. 33 Conclusions Needs driven Physician driven at own cost Data transfer is now secure Regulators – pragmatic approach Guidelines Generic record keeping
  34. 34. 34 WhatsApp Services Is this the new face of telemedicine success in the developing world? Is telemedicine too regulated for this in the developed world?
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