This cross-sectional study aimed to evaluate real-world use of instant-messaging e-consultation among cardiologists in Türkiye, quantify self-reported treatment delays attributed to perceived poor quality of transmitted data, and examine how medicolegal concern varies with professional seniority. The study also tested the internal consistency of a new 15-item tool, the Medicolegal Implications of Digital Consultation in Cardiology Scale (MIDCCS).
A total of 253 cardiologists completed an online survey that captured consultation patterns, acute myocardial infarction (AMI)-related support activities, types of data shared through instant messaging, incidents of treatment delay attributed to data quality, regulatory awareness, and responses to the 15-item MIDCCS. The primary analysis compared MIDCCS domain scores across seniority groups using the Kruskal-Wallis H test with Holm-Bonferroni correction. An exploratory single-item ordinal regression assessed associations with a global measure of medicolegal concern.
Among current users of instant-messaging e-consultation (245 respondents reported current use), 86.9% (213/245) indicated they had performed at least one AMI-related informal support activity via these channels. Reported activities included preliminary assessment (71.5%), triage (60.1%), catheterization laboratory activation support (36.4%), and early management (42.7%). These findings indicate that informal e-consultation via instant messaging was commonly used for urgent cardiac decision support.
The most frequently shared type of clinical data was the ECG, reported by 95.2% of respondents. The survey identified ECG photographs—images taken of printed or on-screen ECGs and transmitted through instant messaging—as a common modality for data sharing. These image-based transmissions were also the most commonly implicated data type in perceived quality failures associated with downstream clinical consequences.
A self-reported treatment delay attributed to perceived poor data quality was endorsed by 23.7% (58/245) of current users. The abstract specifies that delays were most commonly related to ECG photographs, which respondents perceived as lower quality or otherwise inadequate for definitive decision-making. The survey data do not provide objective timing measures or clinical outcomes beyond the self-reported occurrence of delay.
Medicolegal concern, as measured by MIDCCS domains, differed markedly across professional seniority groups. After Holm-Bonferroni correction, every MIDCCS domain showed significant differences between groups (P < .001 in every domain). The pattern reported in the abstract shows that specialists and faculty members recorded higher levels of medicolegal concern than residents. The survey does not report absolute domain scores in the abstract; it documents only the between-group significance and the direction of higher concern among more senior clinicians.
An exploratory ordinal regression model examined the association between a history of treatment delay and a global single-item measure of medicolegal concern. The model produced a directionally positive but not statistically significant association (common odds ratio = 1.711; 95% CI, 0.994–2.946). The abstract notes this as exploratory and nondefinitive.
The 15-item MIDCCS demonstrated good internal consistency with a Cronbach α of 0.86. The primary statistical comparison used the Kruskal-Wallis H test across seniority groups with Holm-Bonferroni correction for multiple comparisons. Details on item-level performance, factor structure, or full domain scoring are not reported in the abstract.
The study concludes that while instant-messaging e-consultation is widespread among cardiologists in Türkiye and functionally supports a range of AMI-related activities, meaningful limitations exist. Data-quality failures—particularly those involving ECG photographs—were associated with self-reported treatment delays in nearly one-quarter of current users. Concurrently, medicolegal concern is greater among specialists and faculty than among residents.
Based on these findings, the authors highlight the need for a secure national e-consultation infrastructure that is integrated with Hospital Information Management Systems, compliant with KVKK data-protection requirements, and end-to-end encrypted. They emphasize that such a platform should preserve the rapid, user-friendly workflow clinicians value in consumer instant-messaging tools (for example, WhatsApp) while addressing data quality and legal/privacy risks.
The abstract reports self-reported data from a cross-sectional survey and does not include objective clinical outcome measures, timestamps, or detailed regulatory familiarity metrics. Item-level MIDCCS scores, full demographic breakdowns, and institutional variation are not provided in the abstract.
Clinicians and health systems using informal instant-messaging for cardiology e-consultation should be aware of potential data-quality limitations—especially when relying on transmitted ECG photographs—and of differing medicolegal perceptions across seniority. The results support development and evaluation of secure, integrated e-consultation platforms that combine clinical speed with robust data protection and quality assurance. Further research using objective clinical outcomes and system-level implementation studies would be needed to quantify effects on treatment times and patient outcomes, but such details were not reported in the abstract.