When a doctor treating a North Carolina nursing home patient asked a nurse to text the resident's lab results, only the two authorized medical professionals saw the message -- but the residential facility ended up paying a high price for using this inherently insecure messaging medium.
The Centers for Medicare & Medicaid Services (CMS) gave the unnamed skilled nursing facility an "e-level deficiency," meaning there was "no actual harm but potential for more than minimal harm," according to a blog by law firm Poyner Spruill. As a result, CMS imposed a 10-point Directed Plan of Correction (DPOC) to be implemented within 15 days, which included:
- Revising HIPAA policies and procedures, including training on identity theft
- Hiring an external contractor -- unrelated to all staff and preapproved by CMS -- to educate employees, physicians, and the governing body during "on-site, in-person, face-to-face" training
- Designating a HIPAA compliance officer for the facility
- Determining how to address any loss of personal health information (PHI) by former employees
- Sending a letter to all residents and families notifying them of the alleged HIPAA violation and the steps the facility is taking to fix and prevent new occurrences
"Neither of these elements was included in CMS's DPOC, nor was there ever any allegation [by CMS] that any PHI was 'lost,' only that it was communicated in isolated instances between a facility nurse and an attending physician, both of whom were authorized to received such information under HIPAA," read the Poyner Spruill blog.
This incident underscores both the government's newly invigorated focus on potential HIPAA violations and the risks associated with unsecured communications.
[Wearable devices could be a boon for healthcare workers, but they must be managed carefully. Read Wearables In Healthcare: Privacy Rules Needed.]
Yet medical professionals continue to rely on texting. In one small study of pediatric hospitalists, 60% admitted to sending texts, 61% received them, and 12% sent or received messages more than 10 times per shift. Almost one third received PHI within a text, and 46% confessed to security concerns with texting. Only 11% of those queried worked at organizations with secure texting services available.
Often medical staff members text to avoid time-consuming alternatives such as paging or using hospital operators, according to Linda Reed, CIO at Atlantic Health System. But while texting addresses timeliness, standard SMS is not HIPAA-compliant. Atlantic discovered that more than half its clinicians used text messaging despite repeated warnings from IT, she noted in an interview.
"We are blue in the face telling our clinicians and nurses, 'You can't do this. SMS is not safe.' At the end of the day, not doing it is not practical," Reed said. "Without us providing some kind of an option, telling them not to do it is an exercise in futility."
Atlantic Health System uses Imprivata's Cortext to ensure secure communications between clinicians, although it also continues to use pagers for some dead zones within its hospitals and physicians' home regions. Because the system is HIPAA-compliant, clinicians can safely text patient information.
Dr. Alex Shen of Torrance Memorial Hospital can get responses in 30 seconds instead of an hour using TigerText. The best part? "I buy back more hours of my day to spend with patients," said Shen.
Secure texting enhances patient safety and physician productivity, Dr. Anthony Hedley, an orthopedic surgeon and founder of Hedley Orthopaedic Institute, told InformationWeek. Hedley uses Photon, a HIPAA-compliant messaging and records-sharing platform that enables doctors to see patients' records and images and add their comments.
"If someone in the hospital, for instance, has a case they would like to consult me on, they can ping me on Photon [and] send me X-rays, CT scans, whatever they want to send on my phone. So I can sit in my home and look at a fractured ankle and either go in to see the patient or advise a referral," he explained. "It's really become like having an intern in your pocket. It is a huge labor saving from that point of view."
Poor communication can force patients to spend unnecessary time in hospital, Dr. Gregory Grant, an orthopedic surgeon and chairman and CEO of Photon Medical Communications, pointed out. When ER doctors cannot reach orthopedic surgeons to review X-rays or CT scans, he said, they may admit patients who don't need a bed -- or conversely, patients with severe injuries may be sent home when non-orthopedic experts cannot pick out major problems on their medical images. In one case, Grant recalled, an ER doctor determined a patient had a severe arm injury and medevac'd the individual to a trauma center.
In another case, an elderly patient scheduled for surgery was given a blood thinner hours before the operation due to a communication lapse. As a result, the surgery was postponed and the patient was hospitalized for an extra day, resulting in potential additional complications and disruption in the hospital's surgery schedule.
Such scenarios worsen patient care and cost hospitals an average of $1.75 million each; in total, US hospitals lose about $11 billion annually because of inefficient pagers, poor communication practices, and cumbersome coordination processes, according to the Imprivata Report on the Economic Impact of Inefficient Communications on Healthcare, conducted by the Ponemon Institute.
Improving communication involves more than just texting, pointed out Reed, who's a nurse by training. At Atlantic Health System, enhanced communication is part of the organization's overriding goal to improve patient care. To achieve that, she said, he provider also bolstered WiFi, implemented virtual desktops, and added Vocera roaming technology for nurses. Videoconferencing is next on the agenda.
"To improve patient care, you need to improve care coordination. And to improve care coordination, you need to improve communication," Reed added.
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