We use WhatsApp on a daily basis to talk to people without meeting in person, to share photos, and to ask quick questions. Sometimes we extend these questions to a group of people to make a decision based on multiple opinions. There’s nothing stopping us from extending this convenience to the medical context.
Instant messaging programs like WhatsApp can be used to consult a group of specialists to get a second opinion on tricky cases without having to wait for all the paperwork and processes which may delay diagnosis and therefore treatment. In a recent study by Sarode et al, WhatsApp was put the test in the field of oral pathologies. A group of 20 oral pathologists (Group B) were gathered virtually using the WhatsApp Broadcast functionality to get a second opinion on 247 cases that were identified as complicated cases by 10 other pathologists (Group A). Cases were shared as photomicrographs taken from microscopes by smartphones with 8 megapixel lens, 3 times zoom power, 640×960 pixels resolution, HDR, and autofocus.
The accuracy of the 4,940 second opinion diagnoses (SOD) was very high, with 98% of SODs correctly diagnosed. In fact, SODs for lesions including adenomatoid odontogenic tumor, keratinizing cystic odontogenic tumor, odontome, dentigerous cyst, etc reached 100% accuracy, while other lesions such as myoepithelial carcinoma, osteosarcoma, fibrosarcoma and intravascular papillary endothelial hyperplasia had lower accuracy (85.71 to 75.75%). For leukoplakia, accuracy was higher for mild cases (94.20%), then moderate cases (84.03%), and finally severe cases (75%). A similar pattern was seen with oral squamous cell carcinoma.
The average time required for a SOD was 83.5 ± 39.08 minutes, ranging from 7 to 478 minutes. This is statistically significantly quicker than that required by traditional means for many oral pathologies.
Needless to say, this study clearly demonstrated that WhatsApp is a good method for getting a quick SOD for oral pathologies without compromising accuracy. As pointed out by the authors, it would be nice if WhatsApp could give users the option of uploading images in full resolution.
Obviously, a remaining concern is privacy and data storage and security when using third party apps like WhatsApp that do not have access control for sensitive patient information. Although WhatsApp has adopted end-to-end encryption earlier this year, using WhatsApp to share patient information is not HIPAA compliant. In any case, there is increasing popularity in exploring remote diagnoses using mobile apps due to its convenience, reach, and timeliness — in the past we have highlighted this for ophthalmology and dermatology.