On text messaging, clinicians can’t think like consumers

Like many of you, I read the May 8th (2017) JAMA article from Dr. Brian C. Dolet regarding the practice of physicians texting Protected Health Information and was pleased to see the topic of texting in healthcare elevated to such a broad audience.

In the article, Dr. Dolet raises several valid points regarding the motivations of physicians to improve their efficiency by leveraging the immediate and convenient nature of text messaging.

Among the important points Dr. Dolet raises are the need to protect PHI, the misleading vendor label of being ‘HIPAA-compliant’, and the recommendation that messages sent via text should be secure and encrypted. We support his findings in these areas and appreciate his raising the visibility of texting in healthcare to the fore. It is in his remaining points that our opinions diverge.

The Patient Safety Risks of De-identification
In his article, Dolet details the practice of “de-identifying” patients by removing up to 18 known pieces of patient data, presumably making it impossible to triangulate a patient’s identity. While he does mention the obvious downside, stating, “deidentification can make it difficult to recognize which patient is being discussed and miscommunication could result...”, he downplays the very real and serious risk to patient safety. In the United States, medical error causes 250,000 deaths each year1 and 37 percent of all high-severity patient injury cases (including death) involved a communication failure2. These are exactly the types of adverse events we routinely hear about from our partner hospitals.

Among its challenges, de-identification is fraught with subjectivity. One caregiver may interpret and de-identify differently than a colleague would, and even though there may a well-defined standard, most physicians would be hard-pressed to name even a few of the eighteen criteria in the Safe Harbor Method for Removing Patient Identifiers cited in Dr. Doler’s piece. As the leading vendor in the clinical communications space, we have observed firsthand among thousands of healthcare customers how flawed texting policies can create gaps in communication and subsequent errors in treatment protocol. In fact, it’s one of the reasons health systems seek out products like ours in the first place.

We have observed firsthand among thousands of healthcare customers how flawed texting policies can create gaps in communication and subsequent errors in treatment protocol.

Why Hospitals Should Not Use Consumer Messaging Apps

It seems entirely plausible that encrypted consumer texting apps like iMessage or What’s App are safe for clinicians to use, after all, they’re encrypted, but this just isn’t the case as these apps lack the fundamental controls needed to ensure patient information remains protected. Here are a few of the areas where they fall short:

● No audit trails for proper message tracking – audit trails are critical
● No IT control over who receives the messages
● No way to wipe messages from a physician’s device when he or she loses privileges or leaves a hospital
● No self-expiring lifespans – messages sent via consumer apps can live indefinitely on both the sender’s and recipient’s devices
● Conversations present on a lost, stolen, or inherited device could be accessed by a third party
● Lack of status indicators that confirm when a message has been delivered and read – a key feature for expediting workflow (When an iOS user texts a user on an Android device)

These points illustrate the fundamental differences between an enterprise-grade clinical communications platform and standard consumer texting apps. The former are purpose-built solutions that have been vetted with intense scrutiny by third-party security agencies such as the HITRUST Alliance to ensure they can match the rigors of healthcare compliance and care delivery, while the latter simply are not.

System Integrations: Where Consumer Messaging Apps Flatline
Healthcare-specific mobile messaging solutions not only provide the proper encryption, safeguards, and administrative controls for patient safety, they enable the types of modern improvements in workflow that result in positive outcomes and enhanced care. Such apps can track in parallel with clinical workflows according to role (Hospitalist, NICU Nurse, etc.) and deeply integrate with common systems like the EHR, ADT, LIMS and PACS for accelerated, more coordinated and smoother care delivery. This level of sophistication just isn’t possible with a consumer texting app which has limited functionality and no integration capability.

A recent study out of Toronto validates the integrated communications approach:
“Specifically, patients who came to the emergency room in the University of Toronto’s system with chest pain could spend nearly a half hour less waiting to be discharged if their doctor received lab results on their smartphone rather than on the hospital’s electronic health record system, a new study published in the journal Annals of Emergency Medicine found.” This level of integration simply cannot be accomplished with consumer-grade messaging apps.

The tools exist to solve the widespread issue of unsecured texting, and the time has come to set aside risky, cryptic, deidentified messages in favor of solutions that can truly move healthcare forward in a way that protects patient safety and makes the communication practices of care providers as easy as possible. De-identified text messaging is flat out dangerous and not in the interest of advancing patient safety or streamlining our current arcane workflow processes.

1Source: National Center for Health Statistics
2Source 2015 Malpractice Risks In Communications report

The views, opinions and positions expressed within these guest posts are those of the author alone and do not represent those of Becker's Hospital Review/Becker's Healthcare. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them.

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