Caroline Helwick

October 21, 2012

NEW ORLEANS — Text messaging is rapidly replacing the traditional pager as a means of communication among pediatric hospitalists, raising concerns about transferring protected health information using unsecure systems, new research shows.

Findings from an electronic survey conducted by researchers at the University of Kansas School of Medicine in Wichita show that more than one half of the physicians reported sending or receiving work-related text messages.

"The way that physicians are communicating appears to be shifting away from the traditional pager method," said lead investigator Stephanie Kuhlmann, DO.

The survey included 106 pediatric hospitalists, the majority of whom were female (68%) and had been in practice less than 10 years (62%). Ninety percent of responders used a "smart phone," and 96% used text messaging.

"Personally, I probably get 50 to 100 text messages during a shift," Dr. Kuhlmann told Medscape Medical News. "But unlike many physicians, I don't carry a pager, so everything comes to my cell phone."

The findings were presented here at the American Academy of Pediatrics (AAP) 2012 National Conference and Exhibition.

Violating HIPAA Rules?

The most frequent methods of communication in the hospital setting remained verbal face-to-face communication (92%) and telephone conversation (92%).

However, more than one half (57%) reported the use of text messaging, and of these, 12% reported sending more than 10 messages per shift (over 8 to 24 hours). Nearly one half (49%) also received work-related text messages when not scheduled to be on call, she said.

Most of these text messages were to or from other pediatric hospitalists (59%), fellows or resident physicians (34%), and subspecialists and consulting physicians (25%).

When asked their preferred mode for brief communication, respondents varied between texting to mobile phones (27%), hospital-assigned pager (23%), and verbal face-to-face exchange (21%).

In the survey, only 5% of physicians indicated that they receive more than 20 messages, so Dr. Kuhlmann's experience appears to be on the far upper end of the spectrum.

The growing use of text messaging to communicate information about patients is cause for concern, according to the survey responses. Many (41%) respondents worried that Health Insurance Portability and Accountability Act (HIPAA) rules can be violated by sending/receiving such messages, and 27% reported having received protected health information through text messages.

However, only 10% reported that their institutions offered encryption software for text messaging.

Behind the Curve

Session moderator Daniel Rausch, MD, associate professor of pediatrics at Mount Sinai Medical Center, New York City, agreed that text messaging is a rapidly emerging form of communication for pediatric hospitalists.

"We think it's a quick method of communication, but there are concerns over HIPAA rules. There are also concerns that this method is distracting, as this has been shown in at least 1 study," he said.

"We need to learn how to use text messaging effectively, because we know this is happening," Dr. Rausch continued. "We are still behind the curve. Technology has jumped ahead of our ability to understand it and regulate it. This study is an attempt to acknowledge our use of text messaging, and it's great that these investigators took time to document this. Hopefully, we will start to look at this more systematically."

Dr. Kuhlmann and Dr. Rausch have disclosed no relevant financial relationships.

The American Academy of Pediatrics (AAP) 2012 National Conference and Exhibition. Abstract 17820. Presented October 21, 2012.

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