The Joint Commission (TJC) and the Centers for Medicare and Medicaid (CMS) have agreed that, “…the impact of secure text orders on patient safety remains unclear.” Therefore the use of secure text orders is not permitted at this time.
In 2011, The Joint Commission published a FAQ document that stated that, “…it is not acceptable for physicians or licensed independent practitioners (LIPs) to text orders for patient care, treatment, or services to hospitals or other health care settings.” In May 2016, TJC reversed their position. Citing advancements in technology and secure text messaging platforms, TJC said that, “…LIPs or other practitioners, in accordance with professional standards of practice, law and regulation, and policies and procedures, [may] use a secure text messaging platform to send orders as long as the system met specific requirements and all the typical required components of an order are included.”
Recently, however, TJC determined that there are still enough concerns about transmitting text orders even when a secure text messaging system is used. According to TJC, and in consultation and agreement with CMS, the impact of secure text orders on patient safety remains unclear. There is thought that the implementation of an additional mechanism to transmit orders may increase burden on nurses to manually transcribe text orders into the EHR which could adversely affect nurses’ ability to do their other critical patient care duties. Additional concern is that texting an order may create situations where additional step(s) are needed to clarify orders prior to order entry resulting in delay in treatment.
To that end, and in collaboration with CMS, TJC has developed the following recommendations:
- All health care organizations should have policies prohibiting the use of unsecured text messaging—that is, short message service (SMS) text messaging from a personal mobile device—for communicating protected health information.
- Notes: In compliance with TJC Standard IM.02.01.01, EP 1 organization’s written policies should address restrictions on the use of unsecured text messaging. Additionally these policies should be reviewed with staff on a routine basis.
- TJC and CMS agree that computerized provider order entry (CPOE) is the preferred method for submitting orders.
- Use of verbal orders remains acceptable in limited situations so long as they are used in accordance with requirements outlined by TJC standards and CMS Conditions of Participation.
- The use of secure text orders is not permitted at this time.
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