Quality & Patient Safety

Call me, beep me: When physicians text

Patient Safety Monitor, March 28, 2018

This is an excerpt from a member only article. To read the article in its entirety, please login or subscribe to Patient Safety Monitor.

As SMS technology has developed, providers have taken to texting patient health information (PHI). They send pictures of X-rays and rashes. They ask opinions and advice on patient cases. They message the on-call physicians that they are needed, ASAP.

In medicine, there are a lot of cost, coordination, and time benefits to a secure SMS. That’s why so many were upset when a miscommunication almost forced them to stop.

An article by the Health Care Compliance Association (HCCA) in December reported that CMS had sent emails saying that “texting is not permitted.”

What CMS meant to say was “texting medical orders is forbidden; secure texting of PHI is fine.” But as the emails were written, many thought they meant “all texting of PHI is forbidden, period.” And healthcare organizations weren’t happy. 

“Secure texting is an integral part of a community platform for organizations,” one manager told the HCCA. “If you pull secure texting out of that pathway, you have disrupted a huge chain of communications that will have a broader effect.”

CMS later explained that it wasn’t placing a blanket ban on texting as a whole. Care team members can text PHI over a secure messaging app, the agency said. They just can’t text medical orders.

“CMS recognizes that the use of texting as a means of communication with other members of the healthcare team has become an essential and valuable means of communication among the team members,” wrote David R. Wright, director of CMS’ Survey and Certification Group. “In order to be compliant with the [Conditions of Participation (CoP)] or [Conditions for Coverage (CfC)], all providers must utilize and maintain systems/platforms that are secure, encrypted, and minimize the risks to patient privacy and confidentiality as per HIPAA regulations and the CoPs or CfCs.

“It is expected that providers/organizations will implement procedures/processes that routinely assess the security and integrity of the texting systems/platforms that are being utilized, in order to avoid negative outcomes that could compromise the care of patients,” Wright added.

While texting PHI is allowed, there are caveats: namely, the types of SMS you use and how you enforce compliance.

Making a texting policy
Frank Ruelas, MBA, a facility compliance professional at St. Joseph’s Hospital and Medical Center Dignity Health in Phoenix, says texting is a case where practice is far outpacing policy and procedures. Providers will text each other no matter what, even in hospitals where it’s prohibited.

“To think that physicians are not texting to other members of the healthcare team is borderline silly,” says Ruelas. “For example, if one walks down the halls of a hospital and spots a physician, he or she probably has their face pointed to their portable device and are either reading or texting. To think none of this involves patient-related matters just doesn’t seem reasonable.”

This is an excerpt from a member only article. To read the article in its entirety, please login or subscribe to Patient Safety Monitor.

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