August 4, 2020

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August 03, 2020

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Not So Fast! — Secure Text Messages May Not Be Used to Transmit Patient Care Orders After All

Reversing the position taken in May 2016, The Joint Commission (TJC) recently clarified that licensed independent providers (LIPs) or other practitioners may not utilize secure text messaging platforms to transmit patient care orders. TJC’s earlier position provided that use of secure text messaging platforms was an acceptable method to transmit such orders, provided that the use was in accordance with professional standards of practice, law and regulation, and policies and procedures.

In reversing its position, TJC identified that concerns persisted regarding transmitting of text orders even when the platform utilized a secure system. Together with the Centers for Medicare & Medicaid Services (CMS), TJC provided four recommendations regarding use of text messaging for patient care orders:

  1. Health care organizations should have policies prohibiting the use of unsecured text messaging (i.e., SMS messaging from a personal mobile device) to communicate protected health information;

  2. Computerized provider order entry (CPOE) systems remain the preferred method for electronically transmitting patient care orders, as CPOE results in the orders being placed in the patient’s electronic health record;

  3. Verbal orders are acceptable where written orders or CPOE are not available; and

  4. Use of secured text messaging to transmit patient care orders is not acceptable.

TJC identified the rationale for the reinstated prohibition against secure text messaging for patient care orders as one of patient safety—after “weighing the pros and cons” TJC and CMS concluded that as the impact of the modality on patient safety remained unclear, and determined that approving its use was premature.

How does this clarification affect health care organizations?

  • Health care organizations that established processes for the use of secured text message platforms for transmission of patient care orders after TJC’s May 2016 approval of such systems should immediately suspend the process and revise their policies and procedures to reflect that secure text message systems may not be utilized to transmit patient care orders (i.e., to reflect recommendation #4, above). 

  • In addition, health care organization policies should clearly state that unsecure platforms are similarly prohibited (in accordance with recommendation #1, above).

  • LIPs and other staff impacted by TJC’ clarification should be educated on the change in position, and provided with update education on any changes to policies and procedures made as a result of the clarification.

Inquiries about the clarification regarding use of secure text messaging may be directed to

© 2020 McDermott Will & EmeryNational Law Review, Volume VI, Number 363


About this Author

Sandra DiVarco Healthcare Attorney Health Systems Lawyer McDermott Will Emery Law Firm

Sandra DiVarco is a partner in the law firm of McDermott Will & Emery LLP and is based in the Firm’s Chicago office. Sandy focuses her practice on the representation of hospitals and health systems. She has counseled health care facility and system clients regarding all aspects of health law transactions and health system restructurings. As a registered nurse, Sandy regularly advises clients on the legal aspects of clinical issues and policy/procedure matters. Sandy also has significant experience in assisting clients with...