Guest blogger Dr. Evan Norfolk discusses the pros and cons of the use of texting for nephrology professionals. Dr. Norfolk is the Associate Director in the Department of Nephrology at Geisigner Medical Center in Danville, PA. He has served on the Dialysis Network 4,9,10 Medical Review Boards and Rehab committees since 2008. If you have questions for him, please leave them in the comments.
As a physician, it’s amazing if you stop at the end of the day and consider how many people you have interacted with-—doctors, nurses and patients. We keep up a hectic pace as we live in a world of multitasking and handheld devices, which enable those interactions. We don’t always have time to talk, but it is easy to send a text message and move on to the next task.
Over this past year, I have spent a fair amount of time looking at the topic of text messaging in the health care arena. I currently oversee a technology subgroup of physicians, which is reviewing the use of texting for Nephrology professionals. My personal bias is that you should not text for patient related matters. Current technology is not ready for medical prime time, which leaves room for errors, adverse patient safety events, or loss of PHI. Like many things in medicine nothing is black and white, is it?
Despite potential for errors, physicians are texting
When we first started the workgroup, I was surprised to find out the number of doctors who were communicating with nurses in dialysis units or hospitals via text message. Perhaps it was a benign message from the nurse ‘patient on HD.’ Implicitly the doc knows the message from Jane means he can stop by in the next 4 hours to evaluate the patient and bill for the dialysis treatment. But what happens when an innocent text includes a question? Hemoglobin 7.5 do you want 2 transfuse? K @ 6.2 do u want to change the K bth? I’m making these up, of course, but they are probable scenarios and it would be naïve to think messages of this caliber are not a daily occurrence. So, what happens when the doc replies? Let’s face it; a quick text answer ‘go ahd’ is easy and convenient. What happens if there was a typo and the nurse meant to enter hemoglobin 5.5 or serum potassium is 3.2?
The upside vs. the downside
To briefly review the pros and cons, texting, or mobile messaging, has been around since the 90’s and provides a quick and easy method to send a message without having to wait for a reply. Cellphones are ubiquitous and almost all of us grab our phone with our car keys when leaving the house. A handheld device makes it very easy to blast out a message without requiring an immediate response. Of course archaic technology developed at a time when pay phones were prominent and the PCs ran windows 3.1 on a 386 processor may have a few limitations. For instance, the character limit is 160. Messages divided into chunks do not necessarily arrive in the order they were sent. There is no delivery confirmation. There are no privacy expectations. There is no way to retract the message if it were sent to someone in your kids’ carpool by accident (which would be a HIPAA violation). Also there is the dreaded, “Did I lose my phone (and all of the data on it)?” question that haunts us when our phones go missing. (Your phone is encrypted and password protected right?) Other downsides include typos, auto correction of information, and spoofing. Finally, remember these messages are not being recorded in the patient record. Important exchanges of information should be captured in the chart for clinical and legal reasons.
HIPAA and HITECH weigh in
The joint commission addresses the use of texting orders on its FAQ page. “No, it is not acceptable for physicians or licensed independent practitioners to text orders for patients to the hospital or other healthcare setting. This method provides no ability to verify the identity of the person sending the text and there is no way to keep the original message as validation of what is entered into the medical record.”
Third party vendors are addressing HIPAA-compliant solutions for smartphones to overcome these limitations. For now, I don’t suggest you use text messaging for patient care. If you must text, make sure you know who you are sending the message to, make sure your phone is encrypted and password protected, remember that sending patient-specific information may open the door to HIPAA and HITECH penalties, and be aware that a message sent does not equal a message received.
So, the next time your ringtone is followed by a note “Call Stat” with no return name or call back number ask yourself, Is texting the way to go? WDUT? (What do you think?)