There is a growing body of evidence highlighting the benefits of mobile health in terms of cost effectiveness, efficiency and patient satisfaction. These benefits have been further enhanced through the development of Instant Messaging (IM) applications (apps) that enable the transmission of images and text messages. The aim of this paper is to review the use of IM in clinical services, and to understand the medico legal concerns with regard to the security and management of protected health information on doctors' phones.

Method: PubMed was searched using the various IM apps as a search term. Inclusion criteria were that the paper was in English and described the use of IM in a clinical service.

Results: 39 papers met the inclusion criteria. Data are at risk at several levels, including during transmission, storage on servers en route, and on the sender's and receiver's phones. Consent is seldom obtained for instant messaging, and confidentiality, privacy, data security and record keeping remain areas of concern.

Conclusion: The use of IM, and in particular WhatsApp, is now commonplace amongst clinicians and used extensively across different clinical services. Security concerns have created barriers preventing the global adoption of IM in healthcare. Guidelines in the management and use of IM need to be developed in order to prevent the unwanted consequences of non-compliance by uninformed clinicians. With improved security, IM has proven to be a viable option in the developing world.