The Joint Commission Issues Clarification on Texting of Patient Care Orders

“The use of secure text orders is not permitted at this time.”

In 2011 the technology to provide for the safety and security of text messaging was not available, and at that time The Joint Commission (“TJC”) said it was not acceptable for practitioners to text orders for patient care and treatment.  Then in May of 2016, TJC acknowledged all of the technology and data privacy and security issues it had in 2011 had been addressed. As published in The Joint Commission Perspectives, TJC revised its position and said physicians could text message when done in accordance with standards of practice, laws and regulations, and policies and practices “as long as the system met specific requirements .”

Since then, however, TJC got together with CMS and recently issued updated recommendations that include the following:

• Providers should have policies prohibiting the use of unsecured text messaging of PHI.
• CPOE (computerized provider order entry) should be the preferred method for submitting orders, which are directly entered into the electronic health record.
• If a CPOE or written order is not available, a verbal order is acceptable, but only when impossible or impracticable to use CPOE or written orders.
• The use of secure text orders is not permitted at this time.After further review the call on the field, as it were, has been overturned.

This turnaround came about after TJC and CMS discussed the issues with numerous stakeholders, including text messaging platform vendors and experts in EHRs. The identified issues that led to the recent decision included:

• Increased burden on nurses to manually transcribe text orders into the EHR.
• Verbal orders are preferred when CPOE not used, because they allow for real-time clarification and confirmation of the order as it is given by the practitioner.
• Text messaging could cause delay in treatment where a clinical decision support (“CDS”) recommendation or alert is triggered during data entry, requiring the nurse to contact the practitioner for additional information.

To view the Dec. 22, 2016 full text article on the TJC website click here to download.