Good Signal? Bad Signal?
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* Maksi Kweka

With technology developing faster than the health services can keep pace with, outsourcing of digital communications services such as DrDoctor patient appointment system, used in Guy's St Thomas, have already shown a 17.2% improvement in patient appointment attendance, simply by adapting to the way in which people communicate today.1 Now, a greater number of medical professionals are turning to solutions that can provide them with a greater level of convenience and security, for communication between each other.

Apps such as the Facebook-owned WhatsApp have become ubiquitous to our everyday lives and are already being used on a regular basis in an informal manner by some in clinical practice. However, there are a number of other contenders in the ring determined to take the crown and topple the longstanding king (the dreaded bleep). Now, since the Information Governance Alliance (IGA) has drafted new guidelines on the use of instant messaging,2 and new rumblings are emerging from top healthcare ministers in the government, we may see a rise in the available options.

A recent article in Digital Health ([www.digitalhealth.net](http://www.digitalhealth.net)) stated that ‘Jeremy Hunt backs call for Whatsapp-style messaging app for NHS staff’, following a recent report by Alan Mak, conservative MP, called *Powerful Patients, Paperless Systems* which seeks to guide both clinicians and patients in the use of new digital healthcare technologies.

Apps such as MedxNote and Medcrowd seek to integrate fully with existing systems inside trusts; however, since they have to be first adopted by the hospital for the service to then be made available to the staff they are not yet an ideal solution for the vast majority of doctors today.

Another free and already popular service is Signal. Signal is surprisingly similar to Whatsapp with just a few more security features for those determined to meet with IGA recommendations. At first glance, you might be forgiven for mistaking it for iMessage or WhatsApp depending on what type of phone you use, with the real difference coming with the features.

The service is end-to-end encrypted with the Signal Protocol which was developed by the company itself and later adopted by Facebook Messenger, Whatsapp, and Google Allo. You can enable a fingerprint lock for the app, all photos are stored in the app itself rather than being downloaded to your phone's gallery storage, as well as disabling the ability to screen capture any conversations, and hiding the contents of messages from notifications. Another interesting feature which currently seems to be unique to the app is the option to set a time limit (à la Tom Cruise in Mission Impossible) which causes the messages to disappear at a specified time after they have been read by the recipient. Which, if your phone is say used by your children to play games after work, could make all the difference. This may seem at odds with good medical record keeping. However, the IGA states that ‘you should not use the instant messaging conversation as the formal medical record. Instead, keeping separate clinical records and ensure original messaging notes are deleted.’

If you're anything like me you may feel that there's a new app coming out every week and that there are more ‘solutions’ than we ever had problems, but Signal seems like a serious contender for those looking to beef up their compliance, at least until there is one officially endorsed NHS app. Until then…don't forget to change the battery in your pager.

*   © Royal College of Physicians 2018. All rights reserved.

## References

1.  1.  Blazer S
    
    
    
    
    1.  Hobson G
    
    
    
    
    1.  Abbs I
    
    Bartlett M, Blazer S, Hobson G, Abbs I. The power of digital communications: improving outpatient attendances in south London. Future Healthcare Journal 2018;5:43–6.
    
    

2.  Hannah Crouch. Information Governance Alliance drafts guidelines for instant messaging use. [www.digitalhealth.net/2018/03/information-governance-alliance-guidelines-instant-messaging-use/](http://www.digitalhealth.net/2018/03/information-governance-alliance-guidelines-instantmessaging-use/) [Accessed 2 March 2018].
    
    

3.  Owen Hughes. Jeremy Hunt backs calls for ‘Whatsapp-style’ messaging app for NHS staff. [www.digitalhealth.net/2018/05/jeremy-hunt-backs-whatsapp-style-messaging-system/](http://www.digitalhealth.net/2018/05/jeremy-hunt-backs-whatsapp-style-messaging-system/) [Accessed 1 May 2018].