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The importance of communication in healthcare

Monday, 4 March 2019  
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Picture: Steve Vlok, Celo co-founder & CEO, and NZHIT Board member


NZHIT guest column by Celo co-founder and CEO Steve Vlok


Effective communication reduces readmissions, but clinicians using consumer communication apps put patient privacy at risk. To prevent this, better privacy legislation and a secure clinical alternative is needed.


More than 25 per cent of hospital readmissions could be avoided with better communication among healthcare teams and between providers and patients (Becker’s Hospital Review).


When a patient visits a hospital or clinic, there are a number of people ranging from nursing staff, administrative staff and doctors who look after them. Even a patient’s family and friends are involved in their care. With so many people involved in someone’s care, communication becomes a critical component in delivering effective, efficient and safe care.


Busy nature of a hospital


A hospital is a busy place. In the life of a surgical registrar at a New Zealand hospital, ward round typically starts at 7am. Here the first face-to-face communication of the day occurs, with a chat to the nursing staff to see how the patients were overnight. Review of vitals follows, before rounding with the team to see the patients, spending time with each patient and assessing their progress.


End-of-ward round results in a talk to the nurse, discussing care plans, dressings, etc. Consultants are then updated (via text or call depending on severity), including any photos, charts or other information for context. The consultant replies to the registrar with a preferred treatment plan (which may be delegated to the house surgeon for action).


Throughout the day, referrals arrive from around the country for the regional service. These typically involve a phone call and a photo shared for more information (via various methods). House surgeons typically keep in contact with the registrars via text to update on any actions. For a nurse to get hold of a house surgeon, they use a pager.


At the end of the day, the house surgeon updates the registrar via text with a summary of the patient’s progress over the day and to update on any investigation results.


Commonly provided tools … a pager, fax machines?


When a junior doctor starts their first job in New Zealand, they are introduced to a pager. This is the provided and expected communication tool between the nursing staff and the typical New Zealand house surgeon.


This archaic artefact is raved about from various powers that be within a hospital environment because of its apparent robustness in a critical event, where the network may be down for internet or mobile coverage.


Along with pagers, the fax machine has a persistent fan base within hospitals, and the health sector can be acknowledged for the survival of an otherwise dated and redundant technology.


What do we use in our ‘normal’ lives?


If you ask any smartphone owner in New Zealand what apps they use on a daily basis, you will hear familiar names such as Instagram, Facebook, SnapChat and WhatsApp. Suffice to say, these applications are such an integral part of people’s day-to-day life that by the very nature of their ease of use and value of connectivity, they have crept their way into the workplace.


The value of smartphones in health


In the healthcare sector, there are mobile devices everywhere, and these are often being used at the point of care. In particular, clinicians at hospitals and healthcare organisations are using consumer text-messaging and instant-messaging apps (which they use in their personal lives) to communicate and discuss patient details due to the convenience of these services.


This can violate health privacy standards, including HIPAA (USA), GDPR (EU & UK), HISO (NZ), or OAIC (AUS).


A recent study published in the British Medical Journal, “The ownership and clinical use of smartphones by doctors and nurses in the UK”, found that 98.9 per cent of clinicians own a smartphone and a majority were wrongfully using consumer applications readily available to non-healthcare professionals. The NHS England states that “WhatsApp should not be used for clinical communications”.


There are numerous benefits to using mobile communication apps within a healthcare organisation. However, there needs to be an emphasis on the use of healthcare-centred messaging apps, the protection of patient data and adherence to strict organisational policies to stay compliant with the law.


New Zealand is lagging behind the rest of the world with privacy legislation


There is an increased urgency among clinicians in New Zealand to be provided compliant tools for communication. This is due to the rapid and ever-increasing legislative requirements worldwide. New Zealand clinicians attending clinical conferences overseas are being made aware of the serious consequences of patient privacy breaches.


It is unacceptable that New Zealand legislation does not mandate the safe handling of New Zealanders’ health data and immediate action is required.



  • New Zealand:
    Privacy Act 1993, Health Information Privacy Code 1994

    $10,000 to $50,000+ fines
  • Australia:
    OAIC Privacy Act, Notifiable data breach

    AU$420,000 fine for individuals, AU$2.1 million fine for corporations 
  • UK/Europe:
    Falls under GDPR.

    €20 million or 4 per cent of annual worldwide turnover (whichever is higher) for any breach of GDPR.

Clinicians must be offered a connected and compliant alternative


Clinicians should have the convenience of texting without putting private patient information at risk, and healthcare organisations and authorities can support them in doing so by providing an easy-to-use and safe alternative to consumer tools. This will ensure clinicians won’t turn to an app store for less-than-ideal solutions, while enabling effective, efficient and safe communication within their care teams.


Steve Vlok is the co-founder and CEO of Celo, and a member of the NZHIT Board.


Read more views:

Ian McCrae: Access to data crucial in the journey towards precision medicine

Darren Manley The key to health system transformation: Good old-fashioned teamwork

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