On December 22, 2016, The Joint Commission (TJC) published clarification regarding the use of secure text messaging for patient care orders for organizations subject to TJC accreditation.   TJC sees this approach as not acceptable at this time.  The implementation of secure text orders was discussed with industry experts and the pros and cons were reviewed and weighed.  Both The Joint Commission and CMS concluded the impact on patient safety remains unclear.  Three main points were made against secure texting for patient care orders:

  • 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. This could adversely affect nurses’ ability to do their other critical patient care duties.
  • 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.
  • In the event that a clinical decision support 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 of treatment.

From a HIPAA perspective, secure texting is allowed when your organization has implemented all the appropriate safeguards, developed policies and procedures, and properly trained its staff.  However, for organizations subject to or seeking accreditation from TJC, secure texting of patient care orders is not acceptable at this time.  The Joint Commission and CMS state they will continue to monitor advancements in the field and provide future guidance if necessary on the use of secure texting to place orders.  Use this link to view the full clarification announcement including texting from personal devices and computerized provider order entry (CPOE):