Joint Commission: Doc texting unacceptable for clinical care

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The Joint Commission just issued a small item that flew under the radars of most hospitals--a message to not allow physicians to use text messaging for patient health information.

The statement itself was a two-sentence response to a frequently asked question on the commission's website, specifically targeting physician orders for patient care.

"[I]t is not acceptable for physicians or licensed independent practitioners to text orders for patients to the hospital or other healthcare setting," the statement said. "This method provides no ability to verify the identity of the person sending the text and there is no way to keep the original message as validation of what is entered into the medical record."

The focus of the response is on target with the commission's long-standing aversion to physicians not physically writing and signing orders, Joint Commission expert and Chicago-based consultant Ode Keil tells FierceMobileHealthcare. The commission's standards for medication management, medical staff and information management all have a similar stance, although none yet specifically address the issue of text messaging, he notes.

"They want docs to take a hands-on approach to writing physical orders, reviewing records, etc., rather than doing it by remote control," Keil says. "That's a philosophical framework that they've adopted for more than a decade."

The Joint Commission doesn't have a specific policy against electronic communications, such as texts, but does put the burden on the hospital to secure any transmissions, according to Keil.

Adds Robert Havasy of Partners Healthcare's Center for Connected Health: "Texting has significant security, privacy and reliability issues making it ill-suited for critical, clinical issues."

The commission's other clear concern is that text messages don't provide a definitive identification for either the sender or the receiver, something it requires for patient privacy compliance.

"I'm presuming [the Joint Commission's] issue is auditability/security, not texting in general," Beth Israel Deaconess Medical Center CIO John Halamka tells FierceMobileHealthcare. "I agree that texting orders provides no provenance of the author, so it should not be allowed in clinical care." 

At least one industry watcher, text-messaging vendor TigerText, interpreted the statement differently, issuing a press release saying the commission had created a "blanket ban" on text messaging for physicians.

Havasy disagreed, saying he "can't imagine this would translate to a blanket ban...but I agree that [text messaging] is not suited to transmitting orders or critical information."

UPDATE: Joint Commission officials tell FierceMobileHealthcare that the FAQ answer was not meant to be a blanket statement of any kind, and that it only applies to the question of texting physician orders. The commission doesn't have any overarching policy on electronic communications, a commission spokesman says, and isn't working to create one. The basic message is that hospitals are required to keep patient information private and secure, and that it's up to each hospital to choose technologies that will do so.

To learn more:
- here's the official Joint Commission statement
- check out TigerText's press release

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