Over the past few years, The Joint Commission, an independent, not-for-profit organization that accredits and certifies nearly 21,000 US healthcare organizations and programs, has had a change of heart about the use of texting patient orders.
In 2011, the organization banned the transmission of HIPAA protected health information (PHI) via text message by personal mobile devices. Specifically, physicians and licensed independent practitioners were not allowed to text any orders regarding care, services or treatment to hospitals or other kinds of healthcare facilities. This decision was handed down because it was believed that the technological capabilities were insufficient to support the safety and security of information contained in text messages of patient care orders.
Then, in May 2016, The Joint Commission lifted the ban after determining that there had been sufficient technological advances in security and safety to support the secure texting of orders. As long as healthcare practitioners followed certain professional standards and guidelines, laws and regulations, and policies and procedures, patient care orders could be sent through a secure text messaging system.
But the rollout of this new policy hit a snag and was halted the following month. Even though patient orders were to be sent on secure text messaging systems, concerns still lingered that there needed to be further measures implemented for texting orders. The Joint Commission was working in collaboration with CMS to ensure that the ruling was congruent with Medicare’s conditions of participation.
While healthcare providers waited for clarification, The Joint Commission, along with CMS, decided in December 2016 that the previous ruling should be rolled back to 2011 standards. Specifically, this means the following:
- CPOE is now the preferred method for order submission, so providers can enter orders into EHR directly. CPOE has become more and more available via encrypted, secure applications for both smartphones and tablets. The Joint Commission believes that this will reduce the burden of the implementation of this policy.
- If a CPOE or a patient care order cannot be electronically submitted, a verbal order may be used, but only as a last resort. Verbal orders should not be used as a shortcut by the ordering healthcare practitioner.
In the past few years, the technology for secured text messaging has advanced — generally speaking — where messages are encrypted end-on-end. With that in mind, it’s unclear as to why The Joint Commission and CMS jointly decided to indefinitely end the use of securely texting patient orders. However, they did find at least three issues in their review of this policy.
- A possible increase in workload for nurses. The implementation of an additional routine — the manual transcription of text orders into EHRs — could detract from the ability to carry out other pertinent patient care duties.
- Verbal orders allow for real-time clarification. This is related to the first issue, the added step of transcribing texts. The benefit of adding secure text messages may be washed out by the task of transcribing the message. If there’s a typo or a question about the text, additional time is added when the ordering practitioner is contacted for further clarification.
- Clinical decision support recommendations/alerts may take additional time. Like the second issue, a clinical decision support recommendation or alert may be made, and whoever is entering the information into the EHR may need to consult with the ordering practitioner for more information. If this is given verbally, the information can be handled in real time. On the other hand, if this is given via text message, then the transcriber must contact the ordering practitioner. These additional steps may delay treatment.
Although these are some compelling reasons — increased workload, decreased clarity, and delayed treatment — mobile devices are becoming more and more a part of professional life, and not just as a means to electronically transmit patient health information into EHRs.
In light of the ban of secure text messaging for orders, I would love for healthcare leaders to look around and think about how we can provide a positive experience using technology. That is the digital world that we live in. Healthcare is unique and challenging, but so is every other industry, and I don’t see other industries limiting the use of technology as much as the healthcare sector does.