Secured Text Messaging Orders Declared Unacceptable by the Joint Commission

In May 2016, the Joint Commission released a statement that originally supported the use of texting for physicians and independent practitioners to transmit orders for patient care so long as they used a secure messaging platform. However, in June 2016, the Joint Commission delayed the implementation of texting patient orders to conduct further research because of growing concern among healthcare organizations.

In conjunction with the Centers for Medicare and Medicaid Services (CMS), the Joint Commission revised its original decision and defined several practice recommendations for healthcare institutions. Healthcare organizations should have policies that prohibit the use of unsecured text messaging of protected health information.

Computerized provider order entry should be the preferred method for submitting orders. This allows for providers to enter orders directly into a patient’s electronic health record (EHR).

If computerized provider order entry isn’t possible, a verbal order is acceptable. However, verbal orders should be used infrequently and should be closely monitored to ensure they’re only used when computerized input is impossible or impractical.

Secured text messaging is unacceptable, because its impact remains unclear. Part of the concern is that adding another mechanism to transmit orders will increase the burden on nurses who must manually transcribe the orders into EHRs. The Joint Commission also noted that verbal orders allow for real-time clarification and confirmation of orders, whereas text messaging does not.

The complexity of orders for patients with cancer could cause hazards if text messaging is used. The inability to ask questions and obtain confirmation raises serious safety concerns when treating patients with cancer. Moreover, texting orders could bypass the use of two patient identifiers associated with an order, which may lead to further potential safety issues. ONS previously expressed its concern with the use of secure text messaging as a form of order communication. With the release of the Joint Commission’s statement, oncology nurses should feel empowered to refuse text messaging as a format for receiving patient orders.

Although technologic advancements are constantly evolving health care, fine tuning is still involved. If the implementation of a new technology increases the burden and potentially complicates care, then the risks are too great. The Joint Commission and CMS noted that they’ll continue to review further advancements and monitor whether secure text messaging systems should be used in the future.