A memorandum was disclosed in December of last year that outlined a new position on texting in healthcare by the CMS. It provided clarity on what is appropriate and, alternately, inappropriate use of text messaging within the walls of the healthcare facilities that process patient information. The newly adopted position avoids explicitly banning the use of text messaging by healthcare providers absolutely, rather, it sets out to convey a firm position on the use of text messaging specifically with regards to patient orders—this distinction includes the use of HIPAA compliant systems to send the patient orders, a widely adopted means of communicating amongst healthcare providers.
The CMS notice regarding patient information states that, “[t]he practice of texting orders from a provider to a member of the care team is not in compliance with the Conditions of Participation (CoPs) or Conditions for Coverage (CfCs).” This statement relays a clear guideline from CMS. However, industry members have experienced revised positions regarding the use of text messages in healthcare that help us to understand why the new guidelines caused controversy when the decision was announced.
Text Messaging in Healthcare—the Ongoing Decision
The new policy clarification by CMS aligns them with the Joint Commission’s stance on the matter. The Joint Commission, an accredited organization designed to ensure compliance with federal regulatory standards for hospitals, is one of several institutions approved by CMS to have standards and a survey process that determines whether institutions meet the Medicare and Medicaid requirements. Leading up to their current position, TJC went through its own series of reversals regarding text messaging. In May of 2016, The Joint Commission released an update to its position on text messaging in hospitals and healthcare settings which had previously stated that it was not acceptable for physicians or practitioners to text orders for patient care. The update reversed its position, allowing providers to “text orders as long as a secure text messaging platform is used and the required components of an order are included.” An evolution in healthcare communications technology was cited as one reason for this decision. Just months later, in July 2016, they reneged their decision temporarily in order to further consider the implications of their decision regarding patient orders.
Subsequently, the Joint Commission worked with CMS to establish appropriate guidelines to regulate the use of text messaging for patient orders. The collaboration resulted in the development of recommendations, including a statement that restricts the use of secure text orders.
As this back and forth suggests, the risks around texting patient orders are both complicated and controversial considering the current widespread adoption of texting in the healthcare industry. This ongoing consideration of text messaging as an accepted means of communication lends itself to the discussion of the recent clarification of guidelines in CMS’ memo last month.
A Closer Look at the Risks of Texting in Healthcare
The latest memo clarifying the agency’s position on texting for healthcare providers was rendered after a story that was issued in the Report on Medicare Compliance newsletter, sent out by the Health Care Compliance Association (HCCA). The story mentions two hospitals receiving emails informing them that “texting is not permitted,” including secure text messaging applications. This raised some questions for the HCCA and their article reports the horror of this decision by compliance officers and healthcare attorneys. One statement by Robert Hudock, Epstein Becker & Green states that the restriction on text messaging would be “like going back to the dark ages.”
It’s clear that texting has become a commonplace method of communication for healthcare organizations. In fact, many have incorporated BYOD policies to take advantage of the convenience of modern technology to enhance the workflow that mobile devices allow. CMS Survey and Certification Group Director David R. Wright wrote that “CMS recognizes that the use of texting as a means of communication with other members of the healthcare team has become an essential and valuable means of communication among team members.”
Wright’s recognition of the importance of texting in the healthcare space begins to address how prevalent this mode of communication has become in the healthcare industry. Indeed, a major element of the HCCA article that ignited some confusion among industry members was the discord about the decision considering just how fundamental text messaging as a means of communication in the industry has become. Restricting texts for hospitals becomes a major hindrance to workflow and connectivity in the industry and the article makes an argument that it creates added risk for patients.
After the change in position which is effective immediately, we are left to wonder just how serious the risks of using text messaging as a means of communication among healthcare personnel is to the privacy and security of the patients they’re meant to protect.
In coming months, the conversation will continue as the healthcare industry continues to adopt advancing technology to help them elevate the standards of patient care.
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