1. Ethical issues: New challenges to the security and privacy of users where sensitive data could be vulnerable to attack by third parties (Ismagilova et al., 2020).
1.1. Anticipated Issues
1.1.1. Confidentiality: Unintentional data breaches using an unsecured mobile application on a personal mobile device.
1.1.2. Access to Internet: Socioeconomic Disparity in access to the Internet to download and access application
1.2. Potential Ramifications
1.2.1. Loss of Trust in Hospital Instant Messaging Application Services
1.2.2. Legal repercussions due to non-compliance with HIPAA
1.3. Approaches to Resolve
1.3.1. Use secure, HIPAA-compliant instant messaging platforms
1.3.2. Educate patients on hospital-secured wi-fi when using application
1.3.3. Ensure best practices as compiled by the Federal Trade Commission (FTC) are used when developing the application (Galetsi et al., 2023)
2. Legal issues: Licensure/authorization/credentialing, data sharing ownership, application regulation/certification/functioning
2.1. Approaches to Resolve
2.1.1. Seek low-privacy risk applications
2.1.2. Stay up-to-date with state and federal privacy practices and regulations
2.1.3. Ensure privacy policy is publicly available in the app page disclosing the collection and use of personal data (Tangari et al., 2021)
2.2. Potential Ramifications
2.2.1. Insecure communication protocols
2.2.2. Legal penalties for non-compliance
2.3. Anticipated Issues
2.3.1. Adverts and Trackers in app traffic: third party receipients of personal data
2.3.2. Regulatory compliance: Ensuring application adheres to local and national laws
3. User issue: the lack of digital application experience and internet accessibility (Wu et al., 2022)
3.1. Anticipated Issues
3.1.1. Digital literacy among patients: Not all patients are comfortable using technology.
3.1.2. Technology access: Some patients may lack access to stable internet or devices for application use.
3.2. Potential Ramifications
3.2.1. Inequality in access to application services
3.2.2. High non use rates for application use
3.3. Approaches to Resolve
3.3.1. Offer technical support before and during application use
3.3.2. Explore providing devices or internet services upon admission and during hospital stay to underserved populations
3.3.3. Develop and use application that is user friendly and easy to navigate (Wu et al., 2022)
4. Financial issues: data integration projects require significant investments in terms of time,money,and resources including skilled personnel, technology infrastructure and ongoing maintenance and support (Onyejekwe et al.,2024)
4.1. Anticipated Issues
4.1.1. Cost of technology setup: High upfront costs for equipment, software, and secure platforms.
4.2. Potential Ramifications
4.2.1. Financial loss hence usage doesnt equate to financial gain.
4.2.2. Patients may face higher out-of-pocket costs to cover use.
4.3. Approaches to Resolve
4.3.1. Advocate for broader use of current instant messanger on EHR platform
4.3.2. Utilize cost-effective application solutions
5. Adoption issues: threats to physicians' professional autonomy with regard to task outside of patient treatment considered as administrative nuisances (Hermes et al., 2020)
5.1. Anticipated Issues
5.1.1. Resistance from providers: physicians who prefer face to face interactions for all concerns may be resistant to change.
5.1.2. Lack of proper training: Some providers may not be well-versed in instant messaging application technologies.
5.2. Potential Ramifications
5.2.1. Reduced quality of care messaging
5.2.2. Decreased adoption of instant messaging services
5.3. Approaches to Resolve
5.3.1. Provide ongoing instant messaging training and workshops
5.3.2. Highlight the benefits of instant messanger such as accessibility