TJC has reversed its position and says that effective immediately, “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,” according to an article in the May 2016 Perspectives.
The ban has been in effect since 2011, when the TJC published a frequently asked question and stated that physicians or licensed independent practitioners should not text orders for patient care, treatment, or services to the hospital or other healthcare settings. TJC leaders were concerned about personal mobile devices being used to send unsecured text messages between providers. Also, with texting, there was no method to verify the identity of the person sending the text and no method for retaining the original message to validate the information entered into the medical record. The TJC says that, at that time, there was no technology to provide safe and secure text messaging of orders.
TJC says that as technology has evolved, there are more secure text messaging platforms. “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,” it said in Perspectives.
Furthermore, TJC says that healthcare facilities can allow orders to be sent through text messaging, as long as a secure text messaging platform is used that includes the following:
- a secure sign-on process;
- encrypted messaging;
- delivery and read receipts;
- date and time stamp;
- customized message retention timeframes;
- specified contact list for individuals who are authorized to receive and record orders.
TJC says that accredited facilities are expected to do the following:
• Comply with Medication Management Standard 04.01.01.
This standard pells out the required elements of a complete medication order and actions that must be taken when orders are incomplete or unclear.
• Develop policies and procedures for text orders.
These policies and procedures should spell out how orders transmitted via text messaging will be dated, timed, confirmed, and authenticated by the practitioner who is submitting the order.
• Consider how to document text orders in the patient’s medical record.
For example, consider the following questions:
- Does the secure text messaging platform integrate directly with the electronic health record?
- Or will the texted order be entered manually?
TJC suggests that providers use requirements addressing verbal orders, Provision of Care, Treatment, and Services Standard PC.02.01.03, and Record of Care, Treatment, and Services Standard 02.03.07, to write policies and procedures for text orders.
While TJC staff determine whether the current standards will be adjusted, it advises accredited organizations to do the following:
- Develop an attestation documenting the capabilities of your secure text messaging platform.
- Define when text orders are appropriate 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.
- Christina Cordero, PhD, MPH, Project Director, Department of Standards and Survey Methods, The Joint Commission. Email: firstname.lastname@example.org.
- Office of the National Coordinator for Health Information Technology. Information on mobile devices and their privacy/security. Web: http://bit.ly/1RYbXD6. Information on managing mobile devices that are used in healthcare settings. Web: http://bit.ly/286o4nS.