By Arun Mirchandani

As provider organizations begin to embrace the idea of texting patient-centric clinical communications, many hospitals and health systems are torn between the increased speed and convenience texting provides, versus the risks it could pose in terms of security, continuity of care and workflow disruption. It’s important that provider organizations address new communication methods systemically and incorporate new channels into a broader clinical communication and collaboration platform, instead of using a piecemeal approach that could result in fragmented patient information and disjointed — rather than coordinated — care.

Why texting apps just won’t cut it
Health care is inherently collaborative, a dynamic that isn’t fostered by using a texting app downloaded from an app store. There’s no way to ensure that texted clinical information goes to the right place without certain built-in mechanisms for interaction, which disqualifies these types of texting apps for use in the health system environment. In marked contrast, an enterprise communication and collaboration platform can facilitate the more robust workflows required to achieve clinical collaboration, including texting clinically relevant care information. In tandem, it also enables an unbroken flow of communication about a patient from one care setting to the next. With such a platform, caregivers can communicate across different devices, including smart-phones, tablets, PCs and voice-activated, hands-free communication badges.



What providers really need
An enterprise communication and collaboration platform should include features such as a continuously updated master directory that identifies who is authorized and available, and interoperability with other clinical systems, including electronic health records (EHRs). The platform should offer security, accuracy, traceability and accessibility to ensure that the right information about the right patient is received by the right person. Key considerations to keep in mind when it comes to implementing technology for texting any clinically-driven collaboration or notification workflow include:

Security. Protecting patient data is paramount. Many texting vendors will claim to meet stringent security guidelines, but hospitals and health systems need to seek concrete evidence that these vendors really understand and are addressing today’s security threats. Vendors should show proof of government and commercial security-related certifications and successfully passed third-party audits. Hospitals and health systems should develop best practices that include not just encrypting texted patient care information or including a date and time stamp, but also protocols to ensure clinically relevant information will go to the right person at the right time.

Wayward text messages can easily lead to confusion that leads to medical errors, just as communication misunderstandings in person can result in those errors. Security considerations should also include chain of custody for mobile devices, which are more vulnerable to loss and theft than bulky desktop computers. All communications, including mobile communications, should be sent and processed in alignment with an enterprise-wide privacy and security policy.

Accuracy and traceability. The communication status of any patient clinical information, along any channel, should be able to be tracked in real time. Upon receipt, the sender should be able to easily confirm that the right person received clinically relevant information, correctly interpreted it and acted upon that information, if necessary.

Accessibility. Information sent via secure text needs to be archived in the patient’s EHR and other systems to ensure continuity of care for patients across all channels, clinicians and health care facilities within a system. Information needed to make clinical decisions should be accessible from the same system that is used to create secure texts. Interoperability with clinical systems, such as EHRs and physiological monitors, provides key contextual data about the patient while creating a record, so that care team members stay on the same page about the patient’s condition.

In addition, workflow integration is critical. The promise of secure texting is that it will ease burdens on providers and speed communication to improve the patient experience. But adding a new communication channel threatens to disrupt workflows if it is not incorporated into existing systems and protocols. The ability to create, maintain and optimize the robust clinical, communication and business workflows that underlie the process of patient care is critical to ensuring the adoption and continued use of the communication system.

Go beyond "compliance." In December 2016, the Joint Commission issued updated guidelines on secure texting that included input from the Centers for Medicare & Medicaid Services (CMS). The new guidelines once again lift the ban on secure texting. However, the commission continues to recommend CPOE as the preferred method for submitting patient orders, reportedly in an effort to minimize errors and ensure patient safety. The updated Joint Commission/CMS guidance now prohibits the sending of physician orders over secure text, which came as a surprise to many in the industry, since secure, EHR-compatible technology and templates exist today that would have made this a viable option for busy care teams.

The new guidelines specify voice communication as the preferred method of handling patient orders if CPOE or written orders cannot be submitted. This stands as a reminder that it is prudent for health systems to take a more comprehensive view of their secure communications. Unlike a limited secure-texting solution, a comprehensive clinical communication and collaboration platform has the versatility — such as voice communication capabilities — necessary to adapt to changes in regulatory and professional guidelines as they arise.

It’s important to note that the Joint Commission’s new secure texting guidelines include very few specifics on the capabilities required to successfully fulfill its requirements. However, in order to operationalize secure texting at scale, health care systems require robust, system-wide solutions. This gap illustrates why taking a narrow, compliance-centric approach to secure texting is inadvisable. Hospitals and health systems should first meet compliance requirements, and then expand their secure texting solution criteria to include how well the technology does or doesn’t facilitate a smart workflow for communication.

Savvy health systems and hospitals are leveraging secure texting as a new, integrated communications channel that will enable their organizations to improve efficiency and patient experience. While we can’t be certain what the future holds in today’s ever-changing regulatory environment, secure texting is likely here to stay. Proactively adopting a comprehensive secure texting solution enables health systems to be compliant while avoiding risks such as compromised patient data and miscommunications that could affect the health and safety of patients.

Secure texting is still in its infancy, and as such, these solutions present exciting opportunities for health care providers to focus on optimizing workflows while improving provider satisfaction and patient safety. By following this advice, clinicians can enjoy this new way of communication without sacrificing convenience for security, or vice versa.

About the author: Arun Mirchandani is senior vice president of products at Vocera Communications Inc. (www.vocera.com), which offers robust clinical communication and collaboration systems.