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Physicians can text patient orders, information to health care teams in hospitals, says CMS

February 15, 2024

Clinicians working in hospitals and critical access hospitals may now text patient information and patient orders to care team members, according to a recent memorandum from the Centers for Medicare & Medicaid Services (CMS). The policy change was sent out to state survey agency directors on February 8 and is effective immediately. (CMS, 2024)

To text patient information, providers must send messages through a secure platform that is compliant with the Health Insurance Portability and Accountability Act (HIPAA). Previously, CMS sent texting guidance to hospitals in 2018 and indicated that the practice of texting patient orders from a physician to a member of the care team was not compliant with the agency’s Conditions of Participation. (CMS, 2024; Muoio, 2024)

In the latest memo, the agency explained that in 2018, it had concerns with record retention, privacy, confidentiality, security, and the integrity of existing systems at the time. CMS wrote that it still prefers that providers enter their orders into the medical record via a computerized provider order entry or a handwritten order. However, the agency acknowledged that it is aware that alternatives exist now, including “significant improvements in the encryption and application interface capabilities of texting platforms to transfer data into electronic health records (EHR).” ((CMS, 2024; Muoio, 2024)

CMS urges organizations to implement procedures and processes that regularly assess the security and integrity of the texting platforms used to avoid negative outcomes that could compromise the care of patients. (CMS, 2024)

Texting is becoming more commonplace in medical settings, but how do physicians feel about it?

In December, the team at NPR’s Planet Money explored this question and highlighted the case study of a well-intentioned effort in the emergency department at San Francisco General Hospital to replace pagers with secure, text-based communication between physicians. Surprisingly, the pilot project failed: most doctors preferred the old system of paging, citing the increased number of texts received and the lowered threshold for communicating (sending a page required succinctness and more intentionality, while texting was easier and resulted in lengthy, frequent communications). The researchers also found no statistically significant change in how long patients spent in the emergency room and as a result, and could not show that the new form of communication delivered value to patients. (Planet Money, 2023)

Similarly, a 2022 study from the Regenstrief Institute, Indiana University School of Medicine and Indiana University Health Methodist Hospital found that, although doctors were happy to replace pagers with clinical texting systems, they were critical of the high volume of messages.

"We found that there is a lack of shared understanding among clinicians regarding how to use clinical texting," said study corresponding author Joy L. Lee, a Regenstrief Institute research scientist and University of Massachusetts Chan Medical School assistant professor, in an announcement about that clinical texting study. (Jercich, 2022)

Ultimately, the paradox of increased communication – more is not always better – will be something to contend with as texting in the clinical setting becomes more the norm, even amongst regulatory agencies.

Sources:

(2024, February 8). U.S. Centers for Medicare & Medicaid Services. Texting of patient information and orders for hospitals and CAHs. Memo #QSO-24-05-Hospital/CAH. [Memorandum]. https://www.cms.gov/medicare/health-safety-standards/quality-safety-oversight-general-information/policy-memos-states/texting-patient-information-and-orders-hospitals-and-cahs.

Guo, J. (2023, December 8). Planet Money. Why do doctors still use pagers? [Podcast]. https://www.npr.org/transcripts/1197955913

Jercich, K. (2022, May 11). Healthcare IT News. Clinical texting is a ‘double-edged sword,’ Regenstrief study finds. https://www.healthcareitnews.com/news/clinical-texting-double-edged-sword-regenstrief-study-finds

Muoio, D. (2024, February 12). Fierce Healthcare. CMS: Providers may now text patient info, orders to care teams. https://www.fiercehealthcare.com/health-tech/cms-providers-may-now-text-patient-info-orders-care-teams