Joint Commission Perspectives®, May 2016, Volume 36, Issue 5 Copyright 2016 The Joint Commission
In 2011 The Joint Commission published a Frequently Asked Question (FAQ) document stating that it is not acceptable for physicians or licensed independent practitioners to text orders for patient care, treatment, or services to the hospital or other health care settings. Sending orders via text messaging was prohibited due to concerns about using personal mobile devices to send unsecure text messages between providers. 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. At the time, the technology available could not provide the safety and security necessary to adequately support the use of text messaging for orders.
As technology has evolved, however, the number of secure text messaging platforms has increased. The Joint Commission recently conducted research to better understand the capabilities of current texting platforms and has concluded that these platforms now offer the functionality to address the concerns outlined in the 2011 FAQ. Therefore, 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. Licensed independent practitioners or other practitioners in accordance with professional standards of practice, law and regulation, and policies and procedures may text orders as long as a secure text messaging platform is used and the required components of an order are included.
Health care organizations may allow orders to be transmitted through text messaging provided that a secure text messaging platform is implemented that includes the following:
- Secure sign-on process
- Encrypted messaging
- Delivery and read receipts
- Date and time stamp
- Customized message retention time frames
- Specified contact list for individuals authorized to receive and record orders
Organizations allowing text orders are expected to comply with Medication Management (MM) Standard MM.04.01.01, which addresses the required elements of a complete medication order and actions to take when orders are incomplete or unclear. Policies and procedures for text orders should specify how orders transmitted via text messaging will be dated, timed, confirmed, and authenticated by the ordering practitioner. Additionally, organizations need to consider how text orders will be documented in the patient’s medical record (that is, does the secure text messaging platform integrate directly with the electronic health record? Or will the texted order be entered manually?). The Joint Commission requirements addressing verbal orders (Provision of Care, Treatment, and Services [PC] Standard PC.02.01.03 and Record of Care, Treatment, and Services [RC] Standard RC.02.03.07) outline several issues that may be adapted into the policies and procedures for text orders.
Staff are currently assessing the need to further delineate the expectations for secure text messaging platforms and policies and procedures for texted orders within the accreditation standards. In the interim, health care organizations that allow text orders are advised to do the following:
- 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
- Conduct training for staff, licensed independent practitioners, and other practitioners on applicable policies and procedures
Resources are available from the Office of the National Coordinator for Health Information Technology (ONC) to assist health care organizations with the use of mobile devices. One resource provides information on mobile devices and health information privacy and security at https://www. healthit.gov/providers-professionals/your-mobile-deviceand-health-information-privacy-and-security. Another ONC resource focuses on managing mobile devices used in health care at https://www.healthit.gov/providers-professionals/ five-steps-organizations-can-take-manage-mobile-devicesused-health-care-pro.
For more information, please contact Christina Cordero, PhD, MPH, project director, Department of Standards and Survey Methods, The Joint Commission, at ccordero@ jointcommission.org.