WhatsApp guidelines - what guidelines? A literature review.

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