Text messaging is a convenient way for busy doctors to communicate, but for years, the question has remained: are doctors allowed to convey sensitive health information with other members of their provider team over SMS? The answer is now “yes,” thanks to a memo published last week by the U.S. Department of Health & Human Services (HHS), Centers for Medicare & Medicaid Services (CMS). The memo clarifies that “texting patient information among members of the health care team is permissible if accomplished through a secure platform.”
However, texting patient orders is prohibited “regardless of the platform utilized” under the CMS hospital Conditions of Participation or Conditions of Coverage, and providers should enter orders into an electronic health record (EHR) by Computerized Provider Order Entry (CPOE).
According to the memo, CMS expects providers and organizations to implement policies and procedures that “routinely assess the security and integrity of the texting systems/platforms that are being utilized” to avoid negatively affecting patient care.
What’s interesting about the CMS memo is that texting on a cell phone has become as routine (if not more routine) as speaking into a cell phone – and HHS published guidance way back in 2013 explaining that the HIPAA Privacy Rule permits doctors and other health care providers to share protected health information over the phone. Telling a 21st century doctor not to communicate by text message (within the proper HIPAA parameters, of course) is like telling the President he can’t communicate on Twitter.
CMS’s restriction on texting patient orders appears to relate to concerns about medical record accuracy, not privacy and security. “CMS has held to the long standing practice that a physician … should enter orders into the medical record via a hand written order” or by CPOE, “with an immediate download into the … [EHR, which] would be dated, timed, authenticated, and promptly placed in the medical record.”
I asked a couple of IT security experts here at Fox how a provider or organization would go about “routinely assessing the security and integrity of the texting systems/platforms” being used by doctors. According Fox partner and Chief Privacy Officer Mark McCreary, CIPP/US, the provider or organization might want to start by:
“… receiv[ing] and review[ing] their third party audits and certifications. Most platform providers would make those available to customers (if not the public). They like to tout their security.”
Matthew Bruce, Fox’s Information Security Officer, agreed:
“That is really the only practical way to routinely assess. SMS, which is standard text messaging, isn’t secure so it would likely require the potential use of third party app like Signal. iMessages are encrypted and secure but only between iPhone users. Both companies should publish their security practices.”
So, providers or organizations participating in Medicare can (continue to) allow doctors to communicate (but not enter treatment orders) by text, but should periodically review the security of the texting systems or platforms the doctors are using. They may also want to remind doctors to make sure they know when and how to preserve text messages, whether by taking screen shots, using an SMS backup app, or some other method.