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ACEP Now: Vol 36 – No 08 – August 2017Here’s a quick rundown.
Text Messages
First up, text messaging during clinical care. I text. You text. Your kids text. Your brother and your mother text. Your patients? They definitely text, often during the physician encounter. Let’s face it: We all text. In fact, 91 percent of all Americans have a cellular phone, and of those, 81 percent report use of text messaging.1
What about doctors? The numbers vary, but according to research cited in an essay written by plastic surgeon Brian Drolet, MD, at the Center for Biomedical Ethics and Society at Vanderbilt University Medical Center in Nashville, studies have found that 60 to 80 percent of physicians text for the purpose of communicating in the context of clinical care.1 The first question is whether using texting (officially known as “short message services,” or SMS) is legal at all.
The good news is that, yes, using texting for communicating medical information with other providers involved in the care of a patient is legal, provided that we are careful. Surprisingly, “being careful” doesn’t only mean that we must use encrypted texting software for these endeavors. In fact, a truly secure and fully encrypted texting platform that physicians can rely on simply does not exist. Long story short, we can use normal text applications on our smartphones, provided that we take precautions in addition to following the normal HIPAA rules. Here are some pointers:
- Protected health information (PHI) must be deidentified.
- A patient’s name (even initials) must not appear in a text.
- Mistakes are possible if, for example, you are texting with a consulting service who is following more than one patient in your department.
- Extra care must be taken, and follow-up phone calls often are advisable.
- A patient’s medical record number should also not appear in a text.
- May physicians text photographs of clinical information to one another? Yes but, again, with precautions. For example, a picture of an ECG may be texted to a cardiology consultant as long as PHI does not appear in the photograph. Even photographs of rashes can be texted, assuming you can find a dermatologist who’s interested.
- Make certain that the patient can’t be identified by the photograph. This means, for example, zooming in on rashes that appear on the face to protect the patient’s privacy.
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One Response to “Medical Texting Tips and SMACC Conference Pearls for Emergency Physicians”
September 5, 2017
Gabe WilsonEncrypted iMessages are more secure than any other means of communication.
Calling your consultant? Have you verified their identity? How do you really know that it’s your consultant that you are talking to? Are they using a cordless phone at home? Have you checked with them to be sure it is frequency hopping ad encrypted and can’t be intercepted? Are they on their cell phone? Have you checked that the signal is not being intercepted or that they are not being overheard?
Prescriptions like those from this article neglect to mention that HIPAA has little directive to say what protocols are required for a means of communication to be considered secure. The authors are holding texting to a completely different standard than any communication we have ever used.
Using a pager still? Have you verified no patient identifiers are being used and that the data is being transmitted securely? Despite paging still being the predominant means of communication in many areas of medicine, not a word about this in the article.
Secure iMessages and other secure encrypted texting compared with any other means of communication we use (unless you work for a government agency and have access to isolated secure rooms) are THE most HIPAA compliant means of communicating possible. More secure than phone calls, pages, and in-person exchanges that can be overheard.
We have to leave this academic space of holding these means of messaging to an entirely different – and artificial standard – compared with the “grandfathered” and still utilized means of communication that are far from HIPAA compliant but for some reason never questioned.
Texting is different and is much less secure – but these days most docs have iPhones or some secure messaging apps.
But as with any technology, secure texting has to be used carefully and thoughtfully. Typos can have significant implications so messages need to be double checked prior to sending, especially more so when clinicians are fatigued.
The bottom line is, what is best and most secure for the patient? You absolutely want patient identifiers on the ECG you are secure texting to the cardiologist. The worst thing possible would be for the cardiologist to think the EKG is for a different patient on her string of texts. Or for the orthopedist to mix up x-rays and give the wrong prescription for fracture care because the x-rays were not labeled with patient identifiers.