WhatsApp, Messaging Apps and the future of Digital Health in the UK

Messaging apps are the future of digital health technology in the UK.

Looking forward 2 years, 5 years, 10 years, secure communication between doctors, patients, clinicians and nurses is going to be an essential utility and productivity tool, potentially unrivalled by any other technology in terms of impact and widespread adoption.

Today though, demand is outstripping supply and healthcare staff are turning to WhatsApp to fulfil their requirements. It is widely acknowledged that WhatsApp is being used across the majority of NHS hospitals.

A recent British Medical Journal study of 2,107 doctors across 5 hospital sites revealed 98.9% of doctors and nurses own a smartphone, and critically around 35% of them use web-based messaging apps to discuss patient care and send clinical information on a regular basis.

The BMJ study concluded "we have demonstrated much higher smartphone ownership among doctors and nurses, who perceive these devices to be useful when performing their clinical duties. Large numbers of staff are sending patient related clinical information using smartphone messaging modalities. Care must be taken by doctors and nurses to ensure that no identifiable patient data is transmitted in this way, and healthcare organisations must develop strategies and policies to support the safe and secure use of these technologies by front-line staff."

"The findings from this study demonstrate that smartphones have become increasingly popular among healthcare professionals who perceive them to be an excellent tool in supporting healthcare delivery. The results provide strong evidence that healthcare organisations need to develop policies to support the safe and secure use of digital technologies in the workplace and that strategies are needed to secure further innovations in digital health."

Healthcare messaging apps in the UK today

So if this is such a large market opportunity and everyone is using WhatsApp, what could fill the demand in the UK?

There are lots of messaging products available in the UK for healthcare professionals to use, all with varying amounts of traction and use, however one clear market leader is yet to emerge leaving potential for more entrants into the market from within healthcare and also from other industries.

Let's look at the 6 main products available in the UK today -

1) Cupris - http://www.cupris.com

Cupris was founded by Jules Hamann, a Consultant ENT Surgeon, and Paul Thomas, an award-winning designer and entrepreneur, to develop medical devices that exploit smartphone technology to improve healthcare communication. Jules felt that a significant proportion of the patients he saw in clinic could be cared for without coming to see him in person.

We believe that smartphone technology can enable examinations to take place closer to the patient's home and away from over-crowded hospitals. Jules, Paul and Mike believe that providing equal access to healthcare for everyone is an essential step in the future of healthcare and want to enable patients to be treated wherever they are, no matter how remote.

2) MedicBleep - https://www.medicbleep.com

Medic Bleep has been developed as a simple and secure solution to the communication challenges that healthcare professionals and wider team in the NHS face while going about their everyday work. This means that if you work in the NHS, Medic Bleep can make your life easier by cutting down on wasted communication time.

We’ve made Medic Bleep super easy to use and available on 3 key platforms – web, iOS, and Android – so you can choose what works for you. If you spend the majority of your time at a desk, we suggest you go for our web version (which works in any browser). If you’re on your feet all day or constantly moving between locations then our iOS (iPhone) or Android mobile/tablet apps give you the flexibility to read and respond to messages on the move.

3) MedCrowd - https://www.medcrowd.com

medDigital was selected to join the first cohort of the DigitalHealth.London Accelerator - a world-class programme that supports SMEs to develop digital health innovations for the NHS. Through this program, medDigital developed medCrowd, a compliant messenger for health and care teams to work together more effectively and give the best care.

Health and care teams are using non-compliant messaging technologies, such as WhatsApp and Facebook Groups, to share confidential health and care information on a daily basis, despite clear guidance from NHS Digital and other professional bodies that only compliant technologies must be used. Therefore, we developed medCrowd to protect confidential health and care information to the right standards. Health and care teams can now join medCrowd and work together compliantly across different organisations all over the world.

4) Hospify - https://www.hospify.com

Founded by two surgeons and a technology journalist, Hospify's mission is to give healthcare workers and patients throughout the UK and Europe a very low cost, reliable, industry-wide, legislatively compliant and data secure text and picture messaging app that they can use as an alternative to the frustrating plethora of partial, local channels that they currently have to rely on.

5) Forward - http://forwardapp.co.uk

Forward seeks to make bleeps, switchboards and paper handover lists a thing of the past, freeing up doctors to do the things that really matter.

Forward is as secure as your NHS email account and is designed to protect both your patients and you. Forward uses end-to-end encryption and stores all data off device in a secure UK hosted cloud in line with NHS Information Governance. Forward users must have access to an approved NHS domain email address. On registering with Forward, a secure activation link will be sent to that address. This unique activation link will expire after 48 hours.

6) CareFlow Connect - www.careflowconnect.com

Founded by two surgeons in 2007, Careflow Connect Ltd was acquired last year by System C Healthcare Ltd, one of the UK’s largest suppliers of health and social care software. Originally based on the principle that secure, mobile, social-media-like technology could improve team working and patient care, Careflow™ is now used by doctors, nurses and other healthcare professionals across NHS Acute, Community and Primary Care and is currently contracted across 18 NHS Trusts and counting. Available via web, native iOS and Android, it provides secure messaging, patient identified care-coordination, alerting & escalations, smart patient lists, ward-round management, handover, task management and patient referrals.

Healthcare messaging apps in the US

Technology innovation tends to start in the US, so what's going on stateside? Is everyone using WhatsApp?

No is the short answer, more than 70+ secure text messaging products exist in the market today as a result of the american healthcare ecosystem fully embracing the need to improve communication between patients, doctors, clinicians, surgeons, nurses and staff.

In the last 3 to 5 years, the development of secure messaging technology has rapidly expanded from a simple real-time communication tool designed to simply secure PHI, to a platform facilitating advanced clinical communication processes and improved patient outcomes. This rapid expansion has negated the need for WhatsApp, however it is safe to say WhatsApp is being used by healthcare professionals in the US, just on a smaller scale.

A direct result of 70+ secure text messaging solutions being available is competition, innovation and the need to diversify. More and more companies are now focusing their attention to large scale enterprise platforms and building combination mobile/desktop solutions that underpin the entire communications structure for healthcare systems and hospitals.

Let's look at a few of the market leading products -

PingMD - a secure messaging app for doctors allowing medical health experts to connect with other professionals as well as their patients. Patients usually download the application only when their doctors are using it or recommend it to them. PingMD is HIPAA compliant and allows you to connect with your physicians the same way you might communicate with a friend or colleague via text messaging, image sharing and so forth.

TigerText - provides secure, real-time mobile messaging for the enterprise, empowering organizations to work more securely. TigerText's encrypted messaging platform keeps communications safe, improves workflows, and complies with industry regulations.

TigerText´s secure healthcare text messaging apps have been implemented in more than 5,000 medical facilities and we currently process more than 150 million secure text messages every day.

The implementation of TigerText´s secure app for texting in healthcare at the Houston Fertility Institute resulted in the organization create a reliable system for securely recording patients´ notes. Scheduling accuracy improved by 20% and an 80% reduction in phone tag was recorded.

QliqSOFT - provides a real-time, HIPAA and HITECH compliant, secure text messaging for healthcare organizations that connects doctors, nurses, and other members of the healthcare team to facilitate patient care.

What about closer to home, are the Dutch one step ahead of the UK?

Dr Michiel van de Sande, oncological orthopaedic surgeon at Leiden University Medical Center (LUMC) in the Netherlands believes Holland are ahead of the UK when it comes to messaging apps in healthcare and points to the fact that over 30% of Dutch doctors have collectively embraced one solution, Siilo https://www.siilo.com which has catapulted them ahead of the competition as the market leading product.

Joost Bruggeman, MD PhD, Co-founder Siilo believes ""Healthcare is in transition. Care is increasingly delivered closer to the home of patients, specialists super-specialize, and locum positions are on the rise. This makes healthcare professionals increasingly mobile and puts pressure on our interrelationships. Siilo helps medical teams to connect and work together."

Ok so why did Siilo become the market leader? Why again like the US are doctors not using WhatsApp on such a large scale?

No-one really knows for sure, Bruggeman has a theory it is because Siilo understood medicine is mobile, always has been and always will be. From pagers to palm pilots, text messages to mobile apps, healthcare professionals have always frequently communicated to each other in order to share knowledge, ask opinions and access information.

He believes "Knowledge is the result of hard work: it involves cognitive and analytic processes after appropriately weighing and collecting information, and in medicine, it is also heavily mixed with professional experience. So first, we were blessed with instantly accessing information. But now, instant messaging has given us the possibility to instantly access knowledge. Thus, your instant messenger has become a new kind of Personal Digital Assistant."

What about further afield, what has been the experience in Australia?

Australia were in a similar position to the UK a few years ago, due to demand from doctors, nurses and healthcare staff, combined with the use of WhatsApp, a number of secure messaging solutions evolved and were released onto the market.

However this evolution of new messaging solutions has not had the same effect as in the US, in fact a lot of healthcare professionals believe the current situation they find themselves in is not a particularly positive one.

Jeremy Knibbs for example commented recently in his article Digital Upheaval Asks Demanding Questions Of Austalia’s Health Sector that ..

"Digital transformation has been slow to arrive to the healthcare sector because the sector is inordinately complex, fraught with risk and regulation and the economics of supply and demand, especially around the services of doctors, has retarded the normal rapid equalisation of informational power that digital brings to the consumer, in this case, the patient.

It is true that the various software and secure messaging vendors, along with the major healthcare data players, like the large pathology providers, have failed largely in Australia to organise well enough to make communication of vital healthcare data efficient and secure. Much of the problem has been a lack of co-operation between competing parties."

Conclusion

The real benefits of secure messaging go way beyond communication, they are about connecting teams and reducing hierarchies to create efficient working environments.

Based on the huge potential of secure messaging, I believe what is needed in the UK is one solution endorsed by government healthcare organisations which has learnt from both the US and Europe in terms of product features, security, UX. UI, auditing, encryption etc... and then applied to meet the needs of local markets in England, Northern Ireland, Scotland and Wales.

This could be part of the national IT infrastructure, for example NHS Digital in England could release their own product or co-develop one in partnership with an existing digital healthcare company.

Alternatively, the Welsh NHS Board for example could hold a Hackathon or open innovation day and ask four or five digital health companies to present their ideas on the best messaging product for the Welsh market and then commission the development of one solution.

Without this approach, more and more solutions will come onto the market, potentially confusing users with different login/registration/authentication/identification processes and ultimately make interoperability and the sharing of data harder and harder as solutions effectively compete for the end user and have little motivation to work together.

Messaging could be a repeat of primary care practice management software ...

Let's continue the debate, tweet @lloydgprice to start a conversation.