In December 2016, The Joint Commission announced its decision to continues its ban of secure messaging as a means for clinicians to place patient care orders. This ban essentially reverts back to the same standards for patient care orders that were set into place in 2011 – despite the technological advances that have been made in secure messaging applications over the past six years. Also in spite of medical professional’s use of less secure means to communicate. The timing of the decision added to the confusion, since the texting ban had previously been lifted in May 2016 and then swiftly put back in place while under further review in July 2016.

Per the most recent December announcement, The Joint Commission, together with Centers for Medicare & Medicaid Services (CMS), cited concerns about doctors using secure text messaging for orders, including potential delays and the additional steps required for clinical staff to input messaged data into electronic health records (EHR). The newsletter noted that clinicians should use the preferred method of computerized provider order entry (CPOE) so that providers can input orders into the EHR, or, under extenuating circumstances, orders should be placed verbally.

Though The Joint Commission’s concerns are justified, considering the healthcare industry is one of the most targeted sectors for cyberattacks, its latest statement against secure text orders for patient care is unreasonable, based on advances in today’s secure messaging platforms. With proper implementation, modern secure messaging platforms not only dispel The Joint Commission’s concerns, but go one step further by proactively addressing security threats that weren’t included in the recent announcement. Further, they can actually provide significantly greater benefits to efficiency and compliance, both greatly sought after in healthcare today.

In fact, secure messaging platforms can address all three of The Joint Commission’s stated concerns, as outlined below:

1) The implementation of an additional mechanism to transmit orders may lead to an increased burden on nurses to manually transcribe text orders into the EHR.

On the contrary, today’s secure messaging technology can seamlessly integrate into a hospital or healthcare organization’s EHR, which allows for comprehensive documentation to the patient record and full archival. This process improves overall efficiency by eliminating the unnecessary step of having to manually transcribe orders, allowing for clinicians to focus on patient care. As an added benefit, secure messaging platforms offer PHI, PII, and IP protection and ensures the privacy of patient records.

2) The transmission of a verbal order allows for a real-time, synchronous clarification and confirmation of the order as it is given by the ordering practitioner.
As the process for texting an order is an asynchronous interaction, an additional step(s) is required to contact the ordering practitioner for any necessary discussion prior to order entry.

By its very nature, verbal dialog is highly susceptible to miscommunication caused by outside factors, misunderstandings or forgetfulness after conversations. Instead, secure messaging platforms provide communication-intensive healthcare organizations with a written transcription delivered in real time that can be easily reviewed by both parties, referred back to after discussions take place, and recorded in an encrypted format that meets compliance standards.

3) In the event that a CDS recommendation or alert is triggered during the order entry process, the individual manually entering the order into the EHR may need to contact the ordering practitioner for additional information. If this occurs during transmission of a verbal order, the conversation is immediate. If this occurs with a text order, the additional step(s) required to contact the ordering practitioner may result in a delay in treatment.

Patient care requires fast-paced, asynchronous collaboration that ensures rapid response for life-saving decisions. In any situation when patient orders or recommendations need further clarifications between two parties, then further dialog – whether written or in person – will be required. Relying on verbal conversations can cause delays due to the steps needed to track someone down by phone or in-person. By having a written record of what was discussed, miscommunication can be quickly identified and errors and alerts can be managed expediently. Also, as time is of the essence in patient care, it should not be understated that text is the most rapidly responded to communication channel that is utilized today with a 98 percent open rate and 45 percent response rate, drastically outpacing both email and voice.

The Joint Commission indicated it will continue to monitor advancements in healthcare to determine “whether future guidance on the use of secure text messaging systems to place orders is necessary.” Considering there are platforms already available that offer secure, ephemeral and compliant messaging to healthcare organizations, we expect The Joint Commission will soon catch up with advances in technology and reverse its stance yet again – this time with confidence, knowing that secure messaging platforms are more secure than SMS texting and more expedient than verbal communications.

(Article originally published in Healthcare Innovations and Technology News and Views by Galina Daskovsky March 20, 2017)