A Response to The Joint Commission’s Position on Texting in Healthcare
In a recent blog post from The Joint Commission, the subject on the use of texting in a Healthcare environment was addressed. The final recommendation was that “Texting is great, and has helped us communicate more quickly in many ways. But for medical care, it’s just not what the doctor ordered.” While the post specifically called out texting as being an inappropriate form of communication, it also mentioned and subsequently constrained the applicability of urgent and critical communications applications to “narrow, select messaging so that communications, instructions, etc. don’t get mixed in with everyday, non-crucial or non-work related text messages.”
Fortunately, under pressure from the field and the evolution of the technology from key companies, such as Zipit, The Joint Commission has pulled the original FAQ on why standard texting was not sanctioned from their website. Kudos to The Joint Commission for recognizing a dated position. We also know that they are working on an official plan that will provide guidance to its healthcare customers. However, for the record, let’s make it clear why we disagreed with The Joint Commission’s position in this recent blog post and why Zipit is committed to working with them to get it right.
The Joint Commission’s previous position overlooks common, day-to-day use cases of solutions like ours while attempting to protect clinical staff from using non-HIPAA compliant forms of communication like standard texting. The post implies that solutions like ours are good for only Code Blue or Code Red use, which we believe is too narrow and does not reflect the nuanced communication needs in today’s healthcare environment. As the saying goes, “don’t throw the baby out with the bathwater.”
A Broader Set of Healthcare Use Cases
The following are some common healthcare situations that justify why Critical Messaging/Secure Texting applications do indeed have a place outside of Code activations:
Lab Requests/Results: Each request is an order that is entered into an EMR or another electronic system and generally is kept inside the system or sent to the recipient via an email, which provides no sense of urgency to the content of the message. In this situation, it is entirely possible that a physician may not see those results in a timely fashion. When dealing with critical lab values, labs commonly process results and then begin the “hunt” to locate physicians by paging or calling them to ensure they reach someone within the required timeframes. If the lab cannot successfully reach the appropriate physician to review the critical lab values within 30 minutes, they must record this situation in the electronic record keeping system. In light of the critical lab values, this scenario shows that traditional methods of communication are an ineffective way of ensuring that hospitals meet these goals.
Patient Admission and Discharge: It is generally known, through numerous studies that outdated communications processes and tools like the ones described above cost hospitals billions of dollars across the system, especially in increased patient admission and discharge time. In one study, sponsored by a third party, patient discharge time was over 100 minutes and could be cut in half if secure texting was used. While it is clear that the convenience of texting improves communication over pagers, secure texting alone is still insufficient as it lacks the time sensitivity required for the admission and discharge processes. Just ask any hospital that has implemented basic, secure texting applications to see if they can still achieve their metrics and hold people accountable! (Note: The study also fails to say when the discharge process was considered to be underway.)
Continuous Workflows: When a nurse issues a patient transport request, the operation is required to be “smooth and continuous.” Similarly, if a patient is pressing a call button in his or her room, requesting assistance to go to the restroom, how much of a delay is considered “ok” before the wait time is considered excessive and the workflow fails to be continuous? How much would patient care improve if, in either scenario, a notification was transmitted to a specific group of people and additional notifications were automatically sent to all members when any one member took ownership of that task?
All of these situations could evidently be improved through the use of comprehensive messaging solutions, but are considered “normal” as was implied by the Joint Commission’s previous recommendations and would thus not fall under the “narrow use cases” that these messaging solutions are constrained to.
Part of a Larger Solution – Electronic Medical Records
In order for patient care to be improved, it is essential that clinical teams communicate effectively. Secure texting and specifically, comprehensive critical messaging solutions must be viewed as a key and integral part of an overall electronic communications/EMR system deployment.
Having a clinical request, like any of the ones identified above – A) Sit in an EMR or email system until a doctor or nurse reads it later in the day when they have the chance to do so or B) Be sent via a secure email notification that gets lost in the inbox like a needle in the haystack is NOT an effective implementation and fails to deliver on the promise of an improved Healthcare system through electronic medical records. By contrast, a reliable and capable secure texting and critical messaging solution would bring the request to clinicians with a sense of urgency.
More Than Just Texting – Comparing Apples and Oranges
Finally, solutions like Zipit’s that include specialized devices, which were designed from the ground up to support healthcare requirements and minimize the risks of PHI exposure through specifically designed infrastructure (authentication, encryption, remote wiping, etc.) should receive special consideration by The Joint Commission. Solutions like these also mitigate the risk of mixing PHI with unrelated information as these devices are only used for business and not personal communication. That is the same reason why businesses purchase computers for use at work, and don’t allow employees to bring their home computers to work – simply put, these are business tools.
In the end, while we truly appreciate and value the fact that The Joint Commission is beginning to clarify their position on non-verbal communication in the Healthcare industry, specifically with regard to texting, it is our recommendation that they work closely with companies like Zipit that understand the growing breakthroughs in communications technology to enable The Joint Commission to stay ahead of the curve in its understanding of what can and cannot be applied to Healthcare. It does a disservice to the doctor and their patients, when regulations based upon antiquated technology prevent comprehensive and powerful solutions to improve the communication process in Healthcare.
It is our belief that secure messaging solutions, with the ability to support critical communications needs as well, are exactly what the doctor needs but even better yet, what the patient expects.
Co-founder, Zipit Wireless