# Instagram and WhatApp in Health and Healthcare: An Overview
## 4 Discussion
### A Plethora of Options
Indeed, the different social media platforms on offer today are not mutually exclusive, and can in fact be synergistic. For example, the US CDC has established a presence on a good number of these platforms (Instagram being just one of them, [10]) to ensure the widest possible dissemination of its public health messages and to reach out to more people wherever they might be online. Different platforms will often have different but also overlapping demographics, and this should be carefully considered and leveraged by health and healthcare organizations when devising their social media outreach strategies. Patient Privacy, Confidentiality and Other Issues Surrounding the Health and Healthcare Uses of Instagram and WhatsApp  
[PERSON] et al. [33; 34] list the following downsides of WhatsApp, some of which might have medicolegal ramifications: frequent interruptions; disparity on urgency; decreased verbal communication; being online 24 h (could also be seen as an upside depending on context); cannot easily print communication record; communications are not readily included in patient's medical record; and identifying patients can be difficult. Other limitations of WhatsApp are to do with Internet connectivity issues, the lack of adequate follow-up in some case discussions, and the variable quality of images [31]. There have also been concerns related to the risks of breaching patient confidentiality and data protection requirements on Instagram and WhatsApp, e.g., [31]. These risks are common to all social media services and not only Instagram and WhatsApp [66]. For clinical photos posted on public Instagram timelines, it remains the poster's (doctor's) full responsibility to protect their patients' privacy and confidentiality (and also observe any applicable content copyrights). The same rules and ethical requirements (including patient consent) for publishing clinical photos in medical journals still apply here. Most reputable health and healthcare organizations have well-established and clear policies governing such clinician ethics and discipline issues as they apply to online environments, including social media. For images privately stored on smartphones, and exchanged among closed groups using WhatsApp and similar apps, there are also risks of breaching patient confidentiality [67; 68; 69]; for example, in cases of unauthorized access (e.g., if the smartphone is left unattended and unlocked); smartphone theft; if the photos are forwarded to the wrong recipients; or if the photos are advertently or inadvertently used beyond their original purpose to which the patient had consented. Measures to address confidentiality of patient data stored on, and exchanged via, smartphones include bolstering smartphone security (e.g., data encryption and remote data wiping in case the device is stolen). Again, organizations often have, and should have, very clear policies, rules and provisions in place regarding these very important information governance issues [69]. [PERSON] et al. [70] point to the fact that when a message is sent from a device via an instant messaging service, the data are relayed to commercial servers that often reside outside of the user's home country via the Internet, where from recipient devices can retrieve messages. This can be problematic in countries such as the UK, where any transmission of sensitive, patient-level data to third-party providers outside the European Economic Area (EEA) would constitute a breach of the Data Protection Act of 1998. In 2014, the National Health Service (NHS) in England enumerated its concerns about instant messaging and advised against using it in clinical exchanges due to problems with data and third-party server security and territory, but this position is gradually changing with the introduction of NHS-oriented apps, such as Babylon Pocket Doctor [71] and Push Doctor [72]. In the US, the Health Insurance Portability and Accountability Act (HIPAA) protects confidential healthcare information, with similar laws in Canada and Australia protecting patients.