Let clinicians text orders, doc argues

Commentary contends practicality outweighs hypothetical concerns

The Joint Commission prohibits providers from texting medical orders, but the restriction makes little sense to clinicians looking to expedite communication in fast-paced, high-stakes work environments, Melissa Walton-Shirley, a Kentucky-based cardiologist, writes for Medscape.

The Joint Commission banned secure-texted medical orders in 2011, citing the potential for insecure platforms, an inability to verify the sender's identity, and concerns about retaining the original message for the medical record. The commission reversed its opinion in May 2016, then—in December—decided to reinstate the ban. It doesn't look like the commission will "revisit the issue anytime soon," Walton-Shirley writes.

"It's odd that communication seems to be the only arena in medicine where we are discouraged from stepping into the 21st century," Walton-Shirley writes. She points out that more than 80 percent of providers uses a smartphone, and "most continue to text in the name of expediency and safety because they choose practicality over hypocritical concerns." After all, she writes, if providers "can rely on a texted description of a scenario to make a decision, [they] should be able to text an order that addresses it."

The case for texting

Walton-Shirley breaks down her argument by comparing texting and verbal communication. "Yes, there are issues regarding the inability to retain texted information in the medical record," she writes, "but how often are verbal conversations placed into the record?" And to those worried about losing texted conversations, Walton-Shirley points out that someone can easily look up how to retrieve deleted information or seek out professional help in doing so.

She argues that privacy concerns are equally hypocritical. According to Walton-Shirley, providers already "speak to and examine patients in [EDs] and clinics and perform stress exams in 'rooms' that are really gurneys separated by thin curtains." They "already talk to anxious families about how well their significant other's procedure went in a common area in front of other waiting families," she adds, and discuss cases "at the door of computer rooms." Walton-Shirley contends, "No one is up in arms about these technically blatant HIPAA violations, yet our ability to affect a life immediately with a smartphone-generated order creates sanctimonious panic."

Moreover, while there's a potential for human error in texting, EHRs and verbal communication "are invitations for human error as well," she writes. She adds, "As much as we try to be careful and thoughtful, there will always be the potential for human error at every step of patient care."

Empowering providers

"The reality," Walton-Shirly contends, "is that squashing an efficient and safe form of communication won't ever happen." She writes, "The capability for light-speed communication has been unleashed, and providers will never go back no matter the latest edict." And texting could even help "reduce burnout by giving back small conveniences like not having to leave church, step out of our child's recital, or exit a noisy restaurant to verbally state an order—we can stay put and text it in a nanosecond," she writes.

Ultimately, providers should be empowered to communicate in the manner that works best for them, whether that be through verbal orders, computerized physician order entry, or texting—and in any scenario, if the message is unclear, providers "should speak on the phone or face to face," Walton-Shirley writes.  

"Patients have always benefited from timely communication and they always will," so providers "should be encouraged to text orders whenever it makes sense," she adds. "It's the right thing to do, and it's high time that we do more of the right things for patients and physicians" (Walton-Shirley, Medscape, 2/8; Minemyer, FierceHealthcare, 2/8).

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