CMS: Secure texting OK, but not for patient orders

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In response to a report that CMS had banned all text messaging between members of a healthcare team, even on secure platforms, the agency reaffirmed its stance that secure texting of patient information is allowed.

The initial report came from a newsletter distributed by the Health Care Compliance Association (HCCA) on Dec. 18, 2017, which cited emails CMS sent to two hospitals saying “texting is not permitted,” including on secure platforms. The HCCA said the CMS stance was based on security vulnerabilities of the phones being used to send or receive the text messages. One unnamed hospital manager said the CMS decision would disrupt “a huge chain of communications,” while an attorney told HCCA not allowing texting “is almost like going back to the dark ages.”

According to CMS, however, its stance on secure texting hasn’t changed. In a memo to state survey agency directors dated Dec. 28, 2017, the agency said texting patient information among members of a healthcare team is allowed if they are done through a secure platform.

“CMS recognizes that the use of texting as a means of communication with other members of the healthcare team has become an essential and valuable means of communication among the team members,” the memo stated.

Texting patient orders remains prohibited, CMS said, regardless of what platform is being used. Order entry should still be entered into a medical record with a hand written order or via Computerized Provider Order Entry (CPOE). Texting orders would put a provider out of compliance with CMS’s Conditions of Participation and Conditions for Coverage.

HCCA didn’t immediately respond to a HealthExec request for comment on the CMS memo.

The Joint Commission has wrestled with this same standard in recent years. After first banning sending orders via text messaging in 2011, the commission announced in May 2016 it would be allowed on secure texting platforms. That change was then delayed by several months and then scrapped altogether in Jan. 2017, concluding along with CMS that “the impact of secure text orders on patient safety remains unclear” and would remain prohibited until further notice.

Among clinicians, it remains a decisive issue. A survey published by the Institute for Safe Medication Practices (ISMP) in Nov. 2017 found 40 percent of respondents—mostly nurses and pharmacists—believed texting orders was only acceptable when using an encrypted device application. A third (33 percent) said orders shouldn’t be texted under any circumstance, and 26 percent of physicians responding to the survey said it should be allowed, compared to 15 percent of nurses and pharmacists and only 4 percent of medication/patient safety officers and risk/quality managers who said the same.