Page 286 - SAHCS HIVMed Journal Vol 20 No 1 2019

Page 2 of 9 Original Research

isolation, lack of locum relief and heavy workload, and this in the United States, or the Data Protection Directive in the
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is seen particularly in rural areas. Much CME traditionally European Union. There are currently no Health Professionals
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happens through conferences, seminars and other face-to-face Council of South Africa (HPCSA) guidelines that address
meetings. These are often difficult to attend which limits the issue of clinicians specifically posting on social media.
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training to attendees only. This is particularly applicable to However, their guidelines address the issue of patient
clinicians working in the Eastern Cape (EC), a predominantly confidentiality, as well as ethical concerns using telemedicine
rural province, where the clinicians enrolled in this study are (which have been extrapolated below to the use of social
working. media). Clinicians who wish to publish details about specific
medical cases or clinical experiences online, which identify
In South Africa, 46% of the population live in rural areas, but or run the risk of identifying a patient, should ensure
only 19% of the nursing workforce and 12% of physicians they follow the guidelines relating to patient consent and
practise in those areas. The EC has a population of 7 million disclosure set out by the HPCSA. These state that a patient’s
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and an HIV prevalence of 12.1%. Approximately 4.1 million express consent must be obtained before publishing case
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of the population live in rural communities. In this setting,
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district hospitals and public health clinics are often reports, photographs or other images in media that the
geographically widespread, with only three academic or public can access. WhatsApp has improved its end-to-end
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tertiary centres servicing these facilities. In addition, the encryption policies and does not store chat data in a virtual
province has only four infectious disease (ID) specialists to cloud (like Facebook), but this form of protection has not
provide expert care to its seriously ill HIV and TB patients. been conclusively tested in clinical environments. Patient
confidentiality is therefore still at risk. The increased use of
Per population size, South Africa (SA) has the largest HIV medical social media, data and information can be very
epidemic in the world. The overall HIV prevalence rate is useful, but any abuse of data needs to be prevented. 14
approximately 12.6%. Similarly, the country’s TB burden is
large. In 2016, SA recorded 438 000 new TB infections. A WhatsApp messenger chat group was created in 2016 for
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TB was the leading cause of death in the country. HIV doctors who had attended an advanced HIV management
treatment and care is often complicated by the emergence of course, and were working in district hospitals in the EC. The
drug resistance, drug–drug interactions and the advanced group included medical specialists and members of the
immune suppression of newly diagnosed patients. district clinical support team. Clinicians posted complicated
cases. The discussion that followed referenced national and
The use of smartphone technology and MIM platforms in international HIV guidelines and evidence-based clinical
clinical practice is a research topic that is gaining support. care. This provided cumulative medical expertise that
Since January 2017, there are 1.2 billion active WhatsApp assisted the clinician in the management of the case.
users worldwide. This service offers users the following
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features: the transmission of text messages, images and videos It is important to know if this intervention is of benefit to
to contacts and a chat group feature that allows 256 users to doctors, particularly those without onsite specialist support
share content simultaneously. 9
in the South African healthcare context. It is also important to
know if clinicians are aware of local occupational governing
However, its use in the public health sector has been poorly authority rules relating to patient confidentiality breaches
researched with only a small number of studies published.
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The literature that is available shows that the use of this when posting on social media. This would raise awareness of
technology offers an efficient, unobtrusive and portable these important ethical and legal obligations in the medical
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mode of communication for medical staff. Not only that, but fraternity. The data obtained from this research could be
also medical images that are captured using smartphone used to motivate for the use of alternative platforms of
devices promote the delivery of medical care in a timely learning and clinician support across different medical
and resource-friendly manner. Kankane et al., in a study specialist modalities besides ID care. This intervention
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of neurosurgical communication, found that WhatsApp could then support the World Health Organization’s (WHO)
enabled cost-effective and quick decision-making, namely recommendation that countries can aid in the retention of
4.06 min from image to registrar report. This led to health professionals by providing them with opportunities
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earlier diagnosis and more prompt treatment. Nikolic et al. for career development, CME, motivation and support. 16
suggest that this technology has the potential to improve
patient education and management, and perhaps, to impact Aim and objectives
significantly on health provision as a whole. 11
Aim
There are obvious concerns, however, about the transmission The aim of this study is to describe the use of a WhatsApp
of confidential patient information over a social media clinical discussion group as an alternative learning tool to
platform. According to international guidelines, patient improve clinician access to specialised clinical management
confidentiality and guarding their personal health data of complicated HIV/TB cases, as part of CME, and their
are a legal requirement under different laws, such as the knowledge of informed consent use when posting patient
Health Information Portability and Accountability Act (HIPAA) cases on social media.

http://www.sajhivmed.org.za 279 Open Access