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Joint Commission Clarifies Text Messaging Rules for Doctors

The Join Commission lifts part of its ban on text messaging for clinicians, but still says doctors can't use the mHealth platform to text patient care orders.

- The Joint Commission is clarifying its guidance on text messaging for providers, saying clinicians can use a HIPAA-compliant platform to send messages to each other but can’t text patient care orders.

The commission reportedly made its latest decision in August, then issued a clarification in its December online newsletter. It continues a summer-long debate over whether mHealth devices and platforms are safe enough to transmit patient information. The organization originally issued the ban in 2011, lifted it this past April, then reinstated it in July, saying it needed more time to “ensure a safe implementation” of text messaging guidelines.

Joint Commission officials said they would work with the Centers for Medicare & Medicaid Services (CMS) on a “comprehensive series of Frequently Asked Questions (FAQ) documents to assist healthcare organizations with the incorporation of text orders into their policies and procedures. This guidance information is designed to supplement the recommendations in the May 2016 Perspectives article permitting the use of secure text messaging platforms to transmit orders.”

The joint recommendations worked out by the commission and CMS are include in the December newsletter are as follows:

  • All healthcare organizations should have policies prohibiting the use of unsecured text messaging - that is, short message service (SMS) text messaging from a personal mobile device - for communicating protected health information.
  • The Joint Commission and CMS agree that computerized provider order entry (CPOE) should be the preferred method for submitting orders as it allows providers to directly enter orders into the electronic health record (EHR).
  • In the event that a CPOE or written order cannot be submitted, a verbal order is acceptable.
  • The use of secure text orders is not permitted at this time.

“The implementation of secure text orders was discussed with numerous text messaging platform vendors, experts in EHRs and other key stakeholders,” the commission wrote. “After extensive discussion weighing the pros and cons of using secure text messaging systems to place orders, The Joint Commission and CMS have concluded that the impact of secure text orders on patient safety remains unclear.”

That discussion, the commission said, revealed three concerns that kept officials from allowing text messaging for patient orders: the increased burden on nurses to manually integrate text orders with the EHR, the burden on providers to clarify any texted orders verbally, and the confusion that may arise if a texted order triggers an alert or CDS recommendation.

“The Joint Commission and CMS will continue to monitor advancements in the field and engage with key stakeholders to determine whether future guidance on the use of secure text messaging systems to place orders is necessary,” the commission wrote.  

In its April ruling opening the doors for text messaging, the commission set up the following guidelines:

  • Develop an attestation documenting the capabilities of their secure text messaging platform ;
  • Define when text orders are or are not appropriate;
  • Monitor how frequently texting is used for orders;
  • Assess compliance with texting policies and procedures;
  • Develop a risk-management strategy and perform a risk assessment; and
  • Conduct training for staff, licensed independent practitioners and other practitioners on applicable policies and procedures.

The commission also established that a secure service must include a secure sign-on process; encrypted messaging; delivery and read receipts; date and time stamp; customized message retention time frames; and a specified contact list for individuals authorized to receive and record orders.

In addition, the commission said any healthcare provider allowing text messaging should comply with Medication Management Standard MM.04.01.01, which establishes a protocol for medication orders and steps to take when an order is unclear or incomplete. And it urged providers to determine if texted orders are automatically entered into the patient’s electronic health record or entered manually. For guidance, it refers providers to the Provision of Care, Treatment and Services Standard PC.02.01.03 and Record of Care, Treatment and Services Standard RC.02.03.07. For guidelines on the use of mobile devices, it advises contacting the Office of the National Coordinator for Health IT (ONC).

In a commentary written in June for mHealthIntelligence.com, PerfectService founder, CEO and president Terry Edwards said a secure text messaging platform for physicians “recognizes the shift that’s happening with technology’s role in healthcare.”

“The biggest impact of the ruling will be on the efficiency of the care team,” he said. “Texting helps avoid ‘phone tag,’ to which many clinicians have become accustomed. For example, when new test results are available, in certain circumstances a nurse must contact the ordering or covering physician to share those results, often via phone. After the nurse reads the results, the physician may respond with a verbal order – medication, therapy or a consult. The nurse would write this order down or enter it into the EHR and then verbally read the order back to the physician to confirm the order is correct. This type of back and forth can be time consuming especially in a busy hospital environment.”

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