Joint Commission Allows Order Texting

Ken Terry

May 09, 2016

The Joint Commission, which accredits most US hospitals as well as other healthcare organizations, has rescinded a 5-year ban on the texting of orders. "Effective immediately, the Joint Commission has revised its position on the transmission of orders for care, treatment, and services via text messaging for all accreditation programs," according to a statement published in the May issue of Joint Commission Resources.

Licensed practitioners may now text orders as long as they use a secure text messaging platform and include the required components of an order, the Joint Commission states.

Healthcare organizations that allow orders to be texted must implement a secure messaging platform that includes a secure sign-on process, encrypted messaging, delivery and read receipts, date and time stamp, customized message retention time frames, and a specified contact list for individuals authorized to receive and record orders. They must also consider how text orders will be documented in a patient's electronic health record.

Furthermore, hospitals and other accredited organizations that allow text orders are advised to:

  • develop an attestation documenting the capabilities of their secure text messaging platform,

  • define when text orders are or are not appropriate,

  • monitor how frequently texting is used for orders,

  • assess compliance with texting policies and procedures,

  • develop a risk-management strategy and perform a risk assessment, and

  • conduct training for staff, licensed independent practitioners, and other practitioners on applicable policies and procedures.

By the end of June, the Joint Commission plans to issue further guidance that will flesh out some of the details of these bullet points, said Christina Cordero, PhD, MPH, project director in the Joint Commission's Department of Standards and Survey Methods, in an interview with Medscape Medical News. The Joint Commission has already received a number of questions on this topic, she said, as well as "positive feedback" to its statement.

When the Joint Commission banned text ordering in 2011, the statement noted, the organization was concerned about the use of unsecure text messaging. "In addition, texting applications were unable to verify the identity of the person sending the text or to retain the original message as validation of the information entered into the medical record," the Joint Commission writes in the newly published statement.

On the basis of recent research, the Joint Commission concluded that the capabilities of current secure texting platforms address its concerns. For example, the secure sign-on process in these platforms ensures that only authorized individuals can send and receive orders between mobile devices.

The Joint Commission statement does not address the substantial security concerns that remain about mobile devices, including questions about the personal smartphones and tablets that many clinicians bring to work. Cordero said healthcare organizations must determine how best to ensure the security of text messages.

"How they decide which devices should have software installed and where those devices are is up to the organization," she noted. "Our concern is that any texting of orders would take place in a secure text messaging platform."

The Joint Commission statement mentions only texting of orders, as that was the subject of the original ban. Asked what the organization's position is on other kinds of clinical texting, Cordero responded, "Our current standards that address the security of patient information would also address any other forms of texting. So we'd still expect that if organizations are using texting for patient updates or other patient information, that that texting is also secure."

The Joint Commission statement noted that accredited organizations must have policies to document texts in the electronic health record, whether electronically or manually. Some EHRs are integrated with some secure texting platforms, enabling providers to document texts automatically, Cordero said. But not all electronic health records have that capability.

A recent study published in the Journal of General Internal Medicine found that secure text messaging can help reduce lengths of hospital stays without increasing readmissions. The University of Pennsylvania study looked at 11,500 patients in two hospitals. One hospital went from a traditional paging system to secure text messaging on certain floors, and its average length of stay dropped from 6 to 5.4 days within a month. No such change was observed in the second hospital, which maintained its paging system.

Jt Comm Perspect. 2016;36:15. Abstract

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