Joint Commission Says Texting Orders Is a No-No, but Maybe Docs Are on to Something

The Joint Commission has issued a statement indicating that health care professionals should not text patient orders. It reads:

“It is not acceptable for physicians or licensed independent practitioners to text orders for patients to the hospital or other healthcare setting. 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.”

I was alerted to this statement by an iHealthBeat article on the topic, which quotes a couple of experts who note that texting has security, privacy and reliability problems that make it unsuitable for critical issues.

I understand the downsides but I’d be interested to learn more about what’s driving the use of texting for orders — if there is in fact such a trend. My guess is that younger physicians in particular are used to texting in their personal lives, finding it convenient, immediate, reliable, concise and likely to be read, acknowledged and acted on quickly. Add to that the fact that texting can easily be done from personal mobile devices and the appeal becomes pretty clear.

It used to be broadly accepted that doctors didn’t like using information technology, but a more likely explanation is that they have an aversion to clunky systems that slow them down and load them up with administrative work that is more suited to administrative support staff. Doctors are big users of smartphones and tablets in their personal lives and have started to bring their own devices and apps into the workplace. It’s fine for the Joint Commission to guard against the downside of such activities, but health care IT providers and health system leaders would do well on how to harness physician enthusiasm for better ways of working and incorporate that input into innovative products and policies that meet the rigorous needs of the health care workplace.

David E. Williams is co-founder of MedPharma Partners LLC, strategy consultant in technology enabled health care services, pharma,  biotech, and medical devices. Formerly with BCG and LEK. He writes regularly at Health Business Blog, where this post first appeared.

10 replies »

  1. The leap from SMS via your carrier to a private app with the same functionality is not a big one, and adds all the privacy necessary. But then, you need to get people on the same platform, generally.

    Worth checking out onereachhealth.com as one solution specific to health care.

  2. Greg

    Where do you work (what type of environment – hospital, clinic, etc)? How is Tigertext used between MD and nurse communication? I am curious. Does the staff find it useful, efficient?

    I think it would be a great tool to implement in hospitals for communication but I am having a hard time finding some real feedback from institutions who are currently using texting.

  3. Very well Said Dr. Mike. I am a clinical coordinator on a busy surgical floor and text our surgeon daily. I have a locked/password screen on my phone, as does he. We are so much more efficient with this method. Agree that someone can enter a typo- but someone can also not correctly hear a telephone order or misinterupt a telephone order. Texting is a written order… Maybe someone can develope a fingerprint app for validation.
    We just need to develop policies regarding texting instead of bucking the idea.

  4. Texting is now being allowed at our facility using Tigertext, which employs all the features necessary to mitigate the risks noted in the article. End to end encryption, using only the Tigertext SMS & MMS servers where data is encrypted at rest; default lifecycle of messages down to 1 minute if desired; the ability to text from a computer desktop to any of the major smartphones O/S; and the ability to print out conversations to add to patient chart.

  5. I have texted orders. The setting was a hospice nurse in the home texted me first, my text was in reply.
    It amuses me that we have come to accept and rarely question the use of a telephone when usually all the criticisms leveled at some new form of communication apply equally well to the phone. Encrypted email? Please. I don’t recall ever encrypting a phone call. Each form of communication has its strengths and weaknesses – we simply need to agree on how to use them wisely, not react with knee jerk distrust of all things new.

  6. Agree on you assessment of the Joint Commission. The JC, NCQA, and their fellow travelers run a protection racket in which their only concern is skimming their share of health care dollars off the top.

  7. The Joint Commission is not a regulatory agency. It is not a licensing agency. It is a rating company. Hospitals pay huge sums for the blessing of TJC. It is nothing short of extortion, in addition to being the contract hit org. for CMS.

    Testing orders illustrates how fast the techscape will change. The boat anchor systems now advocated with meaningless use are DOA.

    I log in at the hospital and no one really knows it is not I. Get out of the way and let the system evolve.

  8. While I believe that careful consideration is necessary before we use texting for orders, I do think that it is a convenient way – perhaps a time saving method – for doctors to use. (Don’t discount me yet.)

    Doctors already use online programs to schedule drug pick-ups.

    But let me hasten to add, safeguards must be put in place. Imagine the overworked and sleepy doctor, his eyes glazing for a second on the screen. He or she miss-punches a number or letter. It goes unnoticed. The message sends. The nurse receives and implements the wrong regimen. Catastrophe.

    Perhaps there is a specific field of medicine for which texting would be more suitable.

  9. Or, maybe the adage “the road to hell is paved with good intentions” really does apply here. Texting is a quick out, and it is a risk to be poorly thought out, just a reflex that cannot be undone. Am I really the only person who regularly comments here who is wary and reluctant to allow the computer process to just take over human interaction? What is the next post when you learn that some lazy ass doctor texts some stupid, clueless order that some equally lazy and inattentive nurse or pharmacist just acts on without contemplation or consideration? What, you all will just say “well, mistakes happen.” Really, when it involves someone you love and care about?

    What is THCB degrading to as another acronym? Total Hypocrisy Completely Belittles? As I finish this comment, I see this title under the Health Plans section of the site: The end of the world as we know it.

    Ah, Irony. What is the text for that!?