Joint Commission, CMS release clarifying recommendations regarding text ordering

The Joint Commission, working with CMS, has released a list of clarifying recommendations in response to the use of text messaging for patient care orders.

In the previously published 2011 FAQ, the Joint Commission stated that the use of text ordering for patient care and services was not acceptable to be used by either physicians or licensed independent practitioners (LIPs) because of the lack of security available for text messaging.

The Joint Commission then noted, in the May 2016 issue of Perspectives, that advancements in technology had allowed for secure text messaging and revised its acceptability of using the technology for physicians and LPIs. Along with following the law, regulations and polices, text messaging of patient care orders is allowed as long as the system meets requirements.

Although previous investigations into text messaging orders found advancements in security measures, concerns arose regarding the sending of text orders even within a secure system. The Joint Commission partnered with CMS to release the following recommendations:

• All healthcare organizations should have policies prohibiting the use of unsecured text messaging—that is, short message service (SMS) text messaging from a personal mobile device—for communicating protected health information.

The Joint Commission Information Management Standard IM.02.01.01 requires organizations to have a written policy regarding the privacy of healthcare information being sent through text messages and limitations must be set on using unsecured text messaging to protect information. These matters must also be discussed to all personnel within the organization. 

• The Joint Commission and CMS agree that computerized provider order entry (CPOE) should be the preferred method for submitting orders as it allows providers to directly enter orders into the electronic health record (EHR).

Using CPOE, an already secure and encrypted application for mobile devices, skips many of the steps needed for text messaging. CPOE also gives providers recommendations and alerts in a faster and more effective manner. 

• In the event that a CPOE or written order cannot be submitted, a verbal order is acceptable.

Noting that the requirements for using verbal orders is outlined in both the Joint Commission standards and the Medicare Conditions of Participation, verbal orders should not take precedent over other ordering methods. Verbal orders should not be used for convenience, but only be used sporadically and be monitored to protect patient information and remain undisruptive in the giving of care.

• The use of secure text orders is not permitted at this time.

The Joint Commission and CMS, after discussing the pros and cons of test ordering with text messaging platform vendors and EHR experts, found that the effects of secure text ordering is too unpredictable regarding patient information security. The two organizations cited the following issues in its conclusion:

• The addition of another method of transmission may put too much of a burden on nurses who must manually input text orders into EHR systems, negatively affecting their ability to perform more important patient care duties.
• The method of verbal ordering takes place in real time while text ordering involves multiple steps in order to purvey a message, taking up crucial time in the process.
• If a CDS recommendation or alert is issued, text ordering has multiple steps in order to contact the ordering clinician and thus affects care. With an individual manually entering orders in an EHR system, the ordering clinician has to be contacted for more information.