Using Secure Text Messaging for the Transmission of Orders for Care

In May 2016, The Joint Commission altered its stance on text messaging, stating that it is now permissible for physicians and licensed independent practitioners to text orders regarding patient care, treatments, or services to hospitals or other healthcare settings, as long as it is done through a secure platform.1

The previous stance of the Commission, issued in 2011, was to prohibit texting such orders because of concerns over the security of personal mobile devices. Apprehension about the inability to verify the identity of the person sending or receiving the text message, as well as the inability to retain the original text message as part of the patient’s medical record, also factored into the decision.

After conducting research on the capabilities of the evolving technology and security measures available for the most recent texting platforms, the Commission came to the conclusion that issues concerning functionality and safety had been resolved since its initial decision.

“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,” the Commission announced in a May 2016 newsletter.1

According to The Joint Commission, a secure text messaging platform used by healthcare organizations includes the following:

  • A protected log-in procedure
  • The ability to encrypt messages
  • Distribution of receipts when a message has been delivered and read
  • Date and time stamping
  • The ability to customize message retention times
  • A contact list of people who are authorized to receive and record orders.
The Commission also asserts that text orders must still follow the Medication Management Standard MM.04.01.01, which outlines the elements needed for a medication order to be considered complete, and what to do if an order is incomplete or unclear.

The Challenges of Implementing Text Orders

With the arrival of patient orders transmitted via text message, practices face a number of new legal and business challenges. The Joint Commission advises healthcare organizations that are allowing patient orders to be sent through text messages to first define when the use of texting is appropriate and provide training on policies and procedures to staff who will be using the platform. How frequently text messaging is used and compliance with policies should be monitored as well.

Healthcare organizations should also verify that they are using a text messaging platform that is secure and has all of the capabilities outlined by The Joint Commission. In addition, a risk management strategy should be developed and a risk assessment should be performed.

Organizations also need to determine how text-messaged orders will be added to a patient’s medical rec­ords. This can be done by entering the orders manually, or by using a text-messaging platform that integrates with the electronic health record to add them automatically.

Is Texting Orders Just the Beginning?

In a recent American College of Radiology Bulletin, Bill Shields, JD, LLM, CAE, and Tom Hoffman, JD, CAE, discussed the benefits that technology—especially text messaging—can have in the practice setting.2

“The mini-conversations you can have by text when conferring with another physician or professional will save time—and can avoid pulling colleagues out of patient exams, surgery, or rounds,” they stated.

Although The Joint Commission makes it clear that their policy only involves texting patients, orders through a secure platform—not the transmission of records, reports, or other information—a recent study explored how the use of secure text messaging by clinical care providers and staff in other areas of patient care may affect outcomes.3

In the study by Mitesh S. Patel, MD, MBA, MS, Assistant Professor of Medicine and Health Care Management, Perelman School of Medicine, and The Wharton School, University of Pennsylvania, Philadelphia, and colleagues, attending and resident physicians, nurses, social workers, clinical research coordinators, pharmacists, and unit secretaries used a secure messaging platform to send and receive patient care information. When compared with a control group of patients whose care providers used more traditional means of communications, there was a relative decrease in the length of hospital stays for patients whose providers used secure mobile text messaging.

The messaging platform used in the study incorporated many of the elements to ensure security that The Joint Commission recommended in its support of the use of text messaging.

“The secure messaging application encrypted text before it was sent via a cellular or wireless Internet connection, and decrypted text before it was viewed. Senders could see when their recipients read the message, and recipients could reply directly using the application,” Dr Patel and colleagues explained.

In a commentary published alongside the article by Dr Patel and colleagues, Maralyssa Bann, MD, Internal Medicine Physician, Harborview Medical Center, University of Washington, Seattle, noted that approximately 15% of the messages sent during the study time frame were done so in group messages, which were defined as comprising more than 1 recipient.4

“In a time when a patient discharge involves 11 different provider roles, on average, interdisciplinary teamwork models are becoming increasingly common and heterogeneous,” Dr Bann said.

“As the current medical practice climate increasingly requires both coordination and efficiency, a group text message may be a valuable communication tool to deliver clinical information in a time-sensitive, consistent manner to multiple care providers,” she added.

Dr Bann concluded that the study results provided a layer of support for the use of secure text messaging as a provider-to-provider communication tool.

Adapting to Changing Technology

The Joint Commission’s change in opinion regarding the use of text messages to convey patient orders represents the need to reevaluate older policies, which may become outdated as technology evolves.

“It is important to recognize that changes to the medium of communication—for example, moving from face-to-face to telephone, or from telephone to mobile secure text messaging—change the effects of the messages. Because communication is so central to effective health care, the recent transformation of communication more generally has the potential to greatly affect clinical care, with the consequent need to evaluate new communication methods in health care just as we might evaluate new drugs, new insurance benefit designs, or new payment policies,” Patel and colleagues concluded.3


  1. Joint Commission Perspective. Update: texting orders. April 29, 2016. assets/1/6/Update_Texting_Orders.pdf. Accessed December 13, 2016.
  2. Shields B, Hoffman T. Can I—should I—text about patient care? 2016. Accessed December 13, 2016.
  3. Patel MS, Patel N, Small DS, et al. Change in length of stay and readmissions among hospitalized medical patients after inpatient medicine service adoption of mobile secure text messaging. J Gen Intern Med. 2016;31:863-870.
  4. Bann M. Capsule commentary on Patel MS, et al., Change in length of stay and readmissions among hospitalized medical patients after inpatient medicine service adoption of mobile secure text messaging. J Gen Intern Med. 2016;31:925.

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