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Vendor calls for reversal of Joint Commission CPOE texting ban

Cries of protest arose when the Joint Commission prohibited secure texting of computerized physician order entries, but now the level of disenchantment among some in the secure text messaging business has ratcheted up with one prominent vendor calling for an straight up reversal of the CPOE ban.

The independent non-profit commission, founded in 1951, works closely with CMS to regulate hospitals and enforce patient safety and other regulations.

In December, the commission, in conjunction with CMS, clarified its recent statements on secure texting by allowing a range of healthcare uses for texting, but explicitly barring it for CPOE. That move spurred much grumbling among the growing ranks of secure messaging vendors.

Now, Galina Datskovsky, CEO of Vaporstream, a Chicago-based secure messaging vendor, is calling on the commission to reconsider and reverse the CPOE prohibition.

“You need to drop the ban, but you can’t allow just any kind of messaging either,” Datskovsky said, adding that it’s reasonable for the commission to mandate such safeguards as read-and-receipt or automatic feed to EHR features. “To outright ban it seems out of touch with the times and reality.”

Datskovsky noted that HIPAA-compliant secure messaging companies such as Vaporstream and others provide permanent records of text messaging strings that can be used to later verify if physicians or nurses submitted or transcribed orders accurately.

She maintained that while the commission allowed phone CPOE, phone communications are usually not recorded or preserved and can often lead to inaccuracies due to bad connections, dropped or static-marred lines and other problems.

“Voice can be ambiguous,” she said.

Also, Datskovsky said text and chat have become so prevalent in the increasingly mobile-first worlds of healthcare and other industries that it has almost reached the status of the preferred communication mode for professionals across many industries. Vaporstream sells into various vertical industries, but healthcare is its biggest sector, she said.

Texting is also usually faster than calling, she said, an advantage in many medical situations when speed is of the essence.

“Everybody texts. It’s just the way of the world,” Datskovsky said. “It’s really difficult in today’s world to get someone on the phone expeditiously. I think it’s actually more dangerous for the patient if you have to wait for a voice confirmation.”

The commission in its December 2016 statement cited, among other reasons, these rationales for the CPOE texting ban:

  • A burden on nurses to manually transcribe text orders into the EHR
  • Verbal orders can be clarified but texting is asynchronous and requires an extra step
  • Texting may add other extra steps by requiring the doctor or nurse to text multiple times for clarification

In any event, the expectation in the wider health IT community is the commission’s ruling will stand.

But don’t be too sure. The commission has reversed itself before.

In 2011 it banned all texting in healthcare, and then in May 2016 lifted that blanket ban, citing technology advances in secure messaging.