A message on or use of messages

When we read the research carried out by Guerra et al. (1) Regarding the use of electronic means in medical practice, we were curious to know what the situation was in Latin America. We intuitively knew that technological advances and, mainly, the need to work remotely due to the pandemic catalyzed their use, but we did not quantify them. We also made it important that the LAHRS become institutionally involved in the matter (2).

A large majority of those interviewed send (89%) and receive (98%) clinical data from patients through two instant message applications. That allows us to affirm that it is an integral part of medical practice. The instruments that we use are the ones that are more widespread in the region and the data obtained is more of an assessment of the situation of the digital market. The type of information shared is expected according to the specialties of the two doctors surveyed. At the top of the list are the different recording modalities of cardiac electrical activity. A majority of two electrophysiologists (71%) stated that they send the information without using the patient’s affiliation data, but 51% stated that they receive clinical information with data that would allow their identification. In that difference we see an important aspect to be reflected. In addition, it is believed that the legal regulations relating to the exchange of sensitive information are not known and, therefore, it is possible that they are not a cause for concern.

The work does not inquire about the use of new technologies that are used between patients and their doctors. This aspect is also an important issue. The heterogeneity in use is probably even greater and may be the cause of inequity in care. They also generate situations of potential risk for patients and doctors. To the former, in their quality of assistance and to the latter in the legal medical field. Another actor involved is the assistance institutions. During the pandemic they were forced to look for alternatives to face-to-face care and this has introduced instruments that will probably last after the emergency. Here are added labor relationship issues with health personnel, which often have not been formally resolved.

It is undeniable that the new information and communication technologies are here to stay. Medical deontology and ethics are also evolving, but not at the same speed. In many respects today they are being challenged. The legislation on the subject in each country can vary and in many it is non-existent. We insist that the survey carried out shows the lack of knowledge we have about this aspect.

In all countries there are codes of medical ethics that we cannot ignore. We also have the code of medical ethics of the World Medical Association (3). There it is established that we have the obligation to “respect the patient’s right to confidentiality. It is ethical to disclose confidential information when the patient gives consent…”. It also says that the physician must “when medically necessary, communicate with colleagues caring for the same patient” and “This communication must respect the patient’s confidentiality and be limited to necessary information”.

These precepts are prior to the existence of new technologies. The question is when and how much should we update them.

Dr. Alejandro N. Cuesta Holgado PhD FESC
Cardiologist – Pediatric Cardiologist – Electrophysiologist
Prof. Adj. University Cardiovascular Center, Clinic Hospital, UdelaR
Head of the Arrhythmia Service, Institute of Integral Cardiology, MUCAM, Montevideo
Pro-Treasurer LAHRS


  1. Guerra, F., Linz, D., Garcia, R., Kommata, V., Kosiuk, J., Chun, J., Boveda, S., Duncker D. Use and misuse of instant messaging in clinical data sharing: the EHRA-SMS survey. Europace. 2021 Aug 6;23(8):1326-1330. doi: 10.1093/europace/euab063

  2. de Oliveira Figueiredo, M. J., Cuesta, A., Duncker, D., Boveda, S., Guerra, F., Márquez, M. F. Use of instant messaging in electrophysiological clinical practice in Latin America: a LAHRS survey. Europace. 2022 Jun 21:euac080. doi: 10.1093/europace/euac080
  3. https://www.wma.net/es/policies-post/codigo-internacional-de-etica-medica/