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Study Questions Safety of mHealth Messaging in High-Acuity Healthcare

The digital health study, conducted by CHRISTUS Health, found that text messaging could be delayed by overworked telephone or Wi-Fi services, possibly endangering patient care.

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- A new study questions the reliability of mHealth messaging in high-acuity care, saying it could lead to patient harm.

Writing in the AHIMA Foundation’s Perspectives in Health Information Management, researchers from Dallas-based CHRISTUS Health say secure clinical texting can be affected by delays (also called latency) when the local telephone network is busy. When urgent care information is involved, that delay could be dangerous.

“Latency can cause potential delays in transmission of patient care information, including information critical to physician clinical decision-making, [and] can also affect text receipt and read confirmations sent from the recipient’s smartphone or tablet back to the sender’s device,” writes George A. Gellert, MD, MPH, MPA, CHRISTUS Health’s associate system chief medical information officer in the Department of Health Informatics. “Because receipt and read confirmations are also at risk of transmission delay due to latency, their intended use as a means of assurance that critical clinical information has been conveyed to the recipient can be uncertain at times of high carrier network activity.”

“Wi-Fi networks within hospitals can experience related issues, such as transient wireless connectivity drops, which can result in similar reliability issues for text transmission and receipt,” added Gellert, who conducted the research with George S. Conklin and Lynn A. Gibson, chief information officer and chief technology officer, respectively, in the Department of Information Management. “In addition, the duration of text delay or latency is determined by constantly changing variables related not only to the volume of traffic that a telecommunications carrier supports at any given moment, but also to the technological signal transmission infrastructure in any particular geographic location.”

The Joint Commission had banned clinician use of text messaging in 2011 before lifting that ban late last year (the restriction remains in place on texting patient care orders). That means doctors can use a HIPAA-compliant platform to send messages, images and data (such as EKGs).

While many in healthcare have hailed the move as an important step in giving clinicians tools to improve patient care, Gellert and his colleagues say there are challenges to using that platform exclusively in a high-acuity care environment.

First, they said, healthcare providers have to ensure that text messages that include clinical care content are integrated with the electronic health record – a challenge in today’s environment, especially when those messages may include images or data.

Second, an analysis of 19 secure clinical texting vendors found that 16, or 84 percent, market their platforms for use in high-acuity areas, for tasks such as transmitting critical lab results, critical patient monitoring alerts and cardiac arrest codes.

t is clear that the secure clinical texting industry needs to ensure that its marketing does not result inadvertently in its customers perceiving that clinical texting can serve appropriately as the only or exclusive channel of critical patient care communications in high-acuity care settings, without telephonic or other validation of the receipt of clinical care information having high urgency and warranting rapid implementation of a care change,” Gellert wrote.

According to Gellert and his colleagues, if the Joint Commission has approved the use of texting in high-acuity areas, and a majority of the platforms on the market say they work well in those areas, clinicians might rely too much on texting. If clinicians do use a texting platform, they wrote, they should call the recipient to make sure the message has gotten through.

“In high-paced, stressful clinical settings, texting could - intentionally or unintentionally - displace telephone contact for non-code but still critical patient care communications. Although clinical judgment and diligence may generally prevent indiscriminate and exclusive text use in high-acuity settings, when patient and work volume increase, errors can occur and reliance on texting may become total,” they wrote. “Clinicians should remain vigilant to identify situations in which communication requires telephone contact to confirm receipt of critical information and thereby ensure the safest care, particularly when acuity is high and when time-sensitive care information requiring immediate action by recipients is texted.”

Gellert and his colleagues say texting is fine for routine, non-urgent care issues, but face-to-face or telephone communications should be the standard in critical environments, where patient care depends on those messages.

“In high-acuity patient care, texts should only supplement - never supplant - telephone contact, or be the sole vehicle of communication,” they concluded.