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 Table of Contents  
Year : 2018  |  Volume : 52  |  Issue : 2  |  Page : 87-88

What's Up(App) Doc?

Prof. and HOD, Department of Orthodontics, SRMC, Chennai, Tamil Nadu, India

Date of Web Publication13-Apr-2018

Correspondence Address:
Dr. Sridevi Padmanabhan
Department of Orthodontics, SRMC, Porur, Chennai, Tamil Nadu
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jios.jios_67_18

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How to cite this article:
Padmanabhan S. What's Up(App) Doc?. J Indian Orthod Soc 2018;52:87-8

How to cite this URL:
Padmanabhan S. What's Up(App) Doc?. J Indian Orthod Soc [serial online] 2018 [cited 2019 May 19];52:87-8. Available from: http://www.jios.in/text.asp?2018/52/2/87/230160

In recent times, the media storm regarding illegal data mining off the Facebook platform by a UK-based company has grabbed widespread attention. Even those of us nebulously aware of the risks and downside of our online jaunts now know with certainty that the information we put out there is potentially going to be used/misused by interested parties.

Over the last decade or so, social networking has changed our lives. Several web-based applications such as Facebook, WhatsApp, LinkedIn, Instagram, and many others have created a platform for friends, family, and professional colleagues to communicate, network, and share information. In India, the WhatsApp application owned by Facebook has over 200 million active users. The advantage of such applications is that they are free, fast, and therefore popular not just for social networking but also for business promotion. The health industry has also recognized the potential of social media and put it to use in a variety of ways. In orthodontics also, social media is acknowledged as a means to promote one's practice.[1] Further, the use of such web-based apps has been suggested to enhance patient compliance.[2]

In addition, instant messaging services such as WhatsApp are popular with health professionals because the cameras fitted in smartphones are good enough to capture and share patient pictures, radiographs, computed tomographic scans, magnetic resonance imaging, and histopathology records. Patients use them for teleconsultation with doctors and doctors may share them with other colleagues for a second opinion, and thus, patient data could be shared within or between health-care teams.[3]

There has been alaramist attention in the press that are reflective of patients' concerns that their personal information is being shared by doctors on social media [4] and this is bound to be true in our neck of the woods also. WhatsApp, in particular, is installed on almost 90% of the mobile phones in India, and it is a given that it is widely used in the medical and dental communities. In the orthodontic fraternity, meticulous patient records and intense case discussions have created a rock solid diagnostic discipline. Our natural propensity for this has led to several online classrooms where there is a lot of knowledge transfer and invigorating discussions. However, this also involves data sharing.

In most countries, WhatsApp does not meet the standards for sharing of clinical information and its use in sharing patient data is frowned upon, and in some countries such as the US, the Health Insurance Portability and Accountability Act places strict regulations on the storage and transfer of medical records.[5] A recent article published in BMJ Innovations sought the input of various stakeholders in the health-care system on the usage of applications such as WhatsApp for sharing patient information and concluded that despite their advantages, they are not safe and caution needs to be exercised in sharing identifiable patient data. The authors opined (and this is probably applicable in India too) that a unified stance by all interested parties is required for the health-care system to take advantage of the immense potential of instant messaging tools to improve and streamline patient care, but bespoke messaging tools that address the issue of data safety might be the future.[6]

In India, the Department of Information Technology of the Indian government released a draft framework and guidelines for the use of social media by government organizations.[7] Although this document may also be adopted by health-care organizations and professionals, it is not specifically directed toward them. The creation of a roadmap in India for the use of electronic medical records is in the formative stages.[8] Thus, in the absence of clear-cut legal or authoritative guidelines on the use of social media by health-care professionals, self-evaluation checklists have been suggested considering the problems that social media can create.[9]

Although the code of ethics put forth by the Medical Council of India and Dental Council of India does not specifically address norms for social media use, the stress on patient confidentiality we are well aware of makes sharing identifiable clinical data on social media a breach of patient confidentiality. It stands to reason that when informed consent is sought from patients before publishing in a scientific journal, the same consideration and discretion would apply manifold when sharing on social media. Informed consent implies that in addition to obtaining consent, the patient is informed as to how exactly the data would be put to use. However, the technology at our trigger-happy fingertips does not really encourage caution and restraint, and other specialties with less identifiable patient records than ours have recognized ahead of us that we have been outsmarted by the smartphone.[5]

How safe is the data on our phones? The end-to-end encryption feature in WhatsApp is one of the purported strengths of the application; however, this is applicable only when the message is sent to a single recipient and not in a multiple-recipient group.[10] Recycling of such data in presentations and articles is hopefully rare but creates the additional risk of intellectual theft. Most of us would admit that we have patient-sensitive information on our phones and getting data from an unattended and unlocked phone is child's play. In the constantly evolving tech world we live in, it is possible to upgrade to the latest gadget but impossible to keep abreast of the pitfalls of such applications. Thus, in issues surrounding data security, patient confidentiality, and intellectual property on social media, it is wiser to be safe than sorry.

Perhaps, this is an instance where the maxim “Sharing is caring” would not apply.

A wiser approach would be “Share IF absolutely necessary, and when sharing, concealing patient identity IS absolutely necessary.”

”The difference between technology and slavery is that slaves are fully aware that they are not free”

- Nassim Nicholas Taleb

  References Top

Jorgensen G. Social media basics for orthodontists. Am J Orthod Dentofacial Orthop 2012;141:510-5.  Back to cited text no. 1
Zotti F, Dalessandri D, Salgarello S, Piancino M, Bonetti S, Visconti L, et al. Usefulness of an app in improving oral hygiene compliance in adolescent orthodontic patients. Angle Orthod 2016;86:101-7.  Back to cited text no. 2
Sarode SC, Sarode GS. WhatsApp use in dentistry: Future prospects. J Dent Res Rev 2016;3:3-4.  Back to cited text no. 3
  [Full text]  
Spencer B. Mail Online. Is Your Doctor Sharing your Medical Details on WhatsApp? Majority of Medics Send Texts and Pictures of Patient Information – Which 'Could Lead to Data Leaks'; 2015. Available from: http://www.dailymail.co.uk/health/article-3264632/Is-doctor -sharing-medical-details-WhatsApp-Majority-medics-send -texts-pictures-patient-information-lead-data-leaks.html. [Last accessed on 2018 Apr 09].  Back to cited text no. 4
Natarajan S, Nair AG. Outsmarted by the smartphone! Indian J Ophthalmol 2015;63:757-8.  Back to cited text no. 5
Chari A, Gane SB. Instant messaging applications in healthcare: Are we harnessing their potential? BMJ Innov [Epub ahead of print]. Available from: http://www.innovations.bmj.com/content/bmjinnov/early/2018/01/24/bmjinnov-2017-000197.full.pdf. [Last accessed on 2018 Apr 09].  Back to cited text no. 6
Framework & Guidelines for Use of Social Media for Government Organizations. Available from: http://www.meity.gov.in/writereaddata/files/Approved%20Social%20Media%20Framework%20and%20Guidelines%20_2_pdf. [Last accessed on 2018 Apr 09].  Back to cited text no. 7
Srivastava SK. Adoption of electronic health records: A roadmap for India. Healthc Inform Res 2016;22:261-9.  Back to cited text no. 8
Visser BJ, Huiskes F, Korevaar DA. A social media self-evaluation checklist for medical practitioners. Indian J Med Ethics 2012;9:245-8.  Back to cited text no. 9


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