Public messaging apps with patient data is a problem
3 years ago we built secure messaging into our platform for sending pictures and messages, people were interested but we seemed to struggle to make a case for adoption.
I’m aware of a number of other apps that have tried, and the NHS has recently supported https://www.medcrowd.com/ via the London Accelerator. The recent reports and news about use of SnapChat and BBC article on WhatsApp are building a case for a solution.
As we speak there will be NHS England / Digital people, local trusts, software companies all about to embark on procurement and software build to solve this. I haven’t began to think about the other nations or even this that other places in the world may have solved this…?
How do we solve this given the eco-system of the NHS?
My question is this: are these proprietary solutions bound to fail in the NHS as the NHS struggles to purchase one thing that gets adoption. Should there be an open approach that provides a secure way of exchanging instant messages between users that allows each vendor or NHS development team to do their own thing, or purchase a solution that is using the standard?
I’m imaging a solution not dislike the Banks payments systems where the open service provides a distributed backbone for secure messaging . The application providers are the hosts and need to store and manage the messages. That would mean that the messaging can be distributed and not require a single service to host the backbone. There would need to be a service discovery solution for users but again that can be distributed and there are standards.
In our implementation we encrypt a key to the AES payload of every message with the public key of the receiving user. The patient is tagged, and we provide access to video and images all encrypted with AES and using public private keys. There are many different approaches to this and standards. But the key is the messages going between services have encrypted payloads and its down the to host applications to manage local security. This would allow differentiation and competition.
Authenticating who the user is will be key, but again there’s a simple process of restricting the users to NHS.net emails initially and having a signup process that involves the users verifying who they are via email. I can also see a care.data type media blow out on this too. So a common open solution would need to satisfy this too, but not get caught up in the OpenID / verify kind of debates.
Consent / GDPR is a big consideration
There are some serious GDPR considerations here too. A doctor who signs up to WhatsApp is doing so in their personal capacity, then using the service as part of their NHS contracted / employed role. So that’s not good from a GDPR view point. How will a patient be able to ask who has had access to there information. Clearly sending images, video or text about a person is identifiable. So what ever solution would also need to manage subject access requests, and also I guess have to have no memory of messages its self but rely on the host systems storing this information.
So can we do some thing as a community are the considerations above so big that it stops it working and by the time we’ve done all this isn’t it just like email in the end?