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The Joint Commission updates stance on text messaging


New guidance on the use of text messaging by physicians shows some flexibility when it comes to HIPAA, notes a healthcare attorney.

The Joint Commission recently announced a change in stance on whether or not it is acceptable for clinicians to use text messaging to submit orders for patient care, treatment or services to a hospital or other healthcare facilities. As an independent, non-profit organization, The Joint Commission works to improve the quality of healthcare through well-recognized and respected certification and accreditation programs. In 2011, the Commission issued a frequently asked questions document, stating that sending orders via text was prohibited due to security concerns. Now, recognizing that technology has evolved, The Joint Commission revised its position, saying that text messaging to convey orders is acceptable, within certain parameters.

John Ferguson, an attorney with Husch Blackwell LLP, in Dallas, says one of the positive aspects of HIPAA “is that as strict as it can be, it does allow for flexibility in how it can be applied.” He says that this change in guidelines on text messaging is evidence of that flexibility, adding, “They saw an advance in technology that mitigated the fears they had” about texting and security. Ferguson finds it encouraging when a government agency adjusts, because, he says, “It’s hard for the law to keep up with technology.”

The change is not so radical that clinicians can simply begin using any SMS platform to send messages to anyone in a professional setting. Most people are comfortable with texting; however, certain security measures are necessary in order to protect patient information. The Joint Commission states clear guidelines for organizations implementing text messaging. Those guidelines include:

●      A secure sign-on process

●      Encrypted messaging

●      Delivery and read receipts

●      Date and time stamps

●      Customized message retention time frames

●      A specified list of contacts who are authorized to receive and record orders

Additionally, organizations are encouraged to set standard policies and procedures for text messaging. Those standards should incorporate both the Medication Management Standard, published by The Joint Commission and the guide by which most healthcare organizations manage the selection and administration of medications, as well as how text orders will be documented into patients’ medical records. The agency is also assessing whether or not more guidance regarding the development of policies and procedures is necessary.


Until The Joint Commission issues more details, the group suggests that any organization drafting policies and procedures develop a method to document the capabilities of the platform in use, clearly state when text messaging is appropriate, track how often text messaging is used to deliver orders, conduct internal audits to confirm compliance, assess risk and provide training for staff.

Ferguson advises practices go over the provisions provided by The Joint Commission first. Then he suggests working with either an internal IT department or seeking help from a consultant, depending on the size of the organization and its financial capabilities, in order to cover all of the parameters of the new guidance. Once everyone understands the provisions, it’s simply a matter of choosing the best platform for the organization. “Then,” Ferguson says, “make sure everyone is using it.”

Getting everyone within a practice to actually use a secure text messaging platform may be more challenging than expected. People are used to texting, and often default to what they know how to do, particularly if the new platform is challenging or unintuitive. Ferguson suggests quarterly internal audits at first, along with heavy internal marketing to encourage adoption of the new platform. It should also be part of the onboarding process for new employees. Once compliance and adoption rise, audits can be conducted less frequently.

Ferguson says he likes the idea that things will naturally fall into place over time, but admits that’s optimistic. Things will come up over time, and practices will have to deal with them as they arise. “The most important thing to recognize is that text messaging [in the healthcare setting] does not mean the same thing as what you use with your family,” concludes Ferguson. 

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