Recently, I had a sobering conversation. One of my colleagues was debriefing me about an onsite hospital visit. The colleague was “shocked” and I quote, “that the house supervisor and physicians were using their personal iPhones to text orders, indicating that this is OK because they didn’t identify the patients at all in the text.”
My risk management alarm is in high alert. What about yours?
The problems with this practice are almost too scary to mention:
- Texting orders is not supported by TJC, thus jeopardizing accreditation.
- Texting an order with no patient identification may seem to comply with HIPAA guidelines, but might result in an order being implemented on the wrong patient.
- Unless the hospital has a policy that allows the nurse to take an MD text and interpret it as a verbal order, she is violating policy, since nurses can only transcribe verbal provider orders. (What part of texting is verbal? Isn’t the point of texting that it is asynchronous and not a verbal interruption?)
- Where is the security of messages sent over a cellular provider network? They track cell phone messages all the time on NCIS! If even a portion of that is realistic, these messages may certainly be discoverable.
The use of personal smartphones is occurring frequently on the job in other industries. Our own survey found that nurses using text messaging in hospitals perceived significantly fewer communication barriers than those in hospitals without texting. Fewer barriers usually results in more unapproved usage, which in this case could result in policy violations, inappropriate access to PHI, or high-risk events. Nurses and healthcare stakeholders are texting in the hospital. We can’t stop them, but we can provide them with a texting system that will protect them, and their patients, from the potential disasters that are keeping me up at night.