The e-Consultation Paradox in Cardiology: The Conflict Between the Clinical Agility of Instant Messaging and Medicolegal Concerns Created by Current Legislation.

Abstract

Objective: To evaluate the clinical use of instant-messaging e-consultation among cardiologists in Türkiye, self-reported treatment delays attributed to the perceived quality of transmitted data, and variations in medicolegal concern according to professional seniority.

Method: A total of 253 cardiologists completed a cross-sectional online survey covering consultation patterns, acute myocardial infarction (AMI)-related support, types of shared data, data quality-related treatment delays, regulatory awareness, and the 15-item Medicolegal Implications of Digital Consultation in Cardiology Scale (MIDCCS). The primary analysis compared MIDCCS domain scores across seniority groups using the Kruskal-Wallis H test with Holm-Bonferroni correction; a single-item ordinal regression analysis of global concern was exploratory.

Results: Among current users, 86.9% (213/245) reported at least one AMI-related informal support activity: preliminary assessment, 71.5%; triage, 60.1%; catheterization laboratory activation support, 36.4%; and early management, 42.7%. The most frequently shared data type was the ECG (95.2%). A self-reported treatment delay attributed to perceived poor data quality was reported by 23.7% (58/245), most commonly involving ECG photographs. Medicolegal concern differed markedly across seniority groups after correction (P<.001 in every domain), with specialists and faculty members scoring higher than residents. In an exploratory ordinal model, a history of treatment delay was directionally but nonsignificantly associated with greater concern (common OR=1.711; 95% CI, 0.994-2.946). The MIDCCS demonstrated good internal consistency (Cronbach α=0.86).

Conclusion: Although e-consultation was widespread and clinically functional, data quality failures and seniority-related medicolegal concerns indicate important limitations. The findings highlight the need for a secure national e-consultation infrastructure integrated into Hospital Information Management Systems that is KVKK-compliant and end-to-end encrypted, while remaining as fast and user-friendly as WhatsApp.