6th Edition In Depth: Text Messaging of Patient Orders
Standard COP.2.2: The hospital develops and implements a uniform process for prescribing patient orders.
Standard COP.2.2 in the JCI 6th Edition Hospital Standards requires hospitals to develop and implement a uniform process for prescribing patient orders. New to COP.2.2 in the 6th Edition, hospitals that allow text messaging of patient orders need to ensure a secure text messaging platform and monitor the process of communication for clarification when questions arise.
Hospitals are not required to allow text messaging of patient orders; however, if they choose to allow it, the expectation is that the hospital meet the applicable requirements in COP.2.2. The goal is to ensure patient safety and maintain patient confidentiality and data security.
Although all measurable elements in COP.2.2 apply to texted orders, MEs 5 and 6 specifically address orders transmitted through text messaging:
Measurable Elements of COP.2.2
5. When hospitals allow orders to be transmitted through text messaging, the hospital ensures the process is through a secure text messaging platform and complies with a) through g) (listed below) in the intent.
6. When hospitals allow orders to be transmitted through text messaging, the hospital collects data to monitor the process of communication for clarification when questions arise.
Each of the requirements a) through g) in the intent of COP.2.2 (listed below) would be addressed by one or more of the following: a vendor’s software, the native application on the mobile device used, a third-party application, a software add-on, or a combination of these. The requirements are also addressed in hospital policy.
The following describes how each requirement may be addressed within a secure text messaging platform:
a) Secure sign-on process(es) – This may be part of the native application on the mobile device being used, a third party software for single sign-on, a VPN solution provider, or a combination thereof.
b) Encrypted messaging – Some native applications provide this functionality, or it can be addressed through an add-on feature or third party application.
c) Prohibited use of unsecured text messaging (for example, short message service (SMS) text messaging) – This would be addressed in hospital policy and can be a function of the application.
d) Delivery and read receipts – This may be a built-in feature (or add-on feature) of the software.
e) Date and time stamp – Typically, this would be a built-in feature of the software.
f) Customized message retention time frames – This would be addressed by hospital policy and through a built-in or add-on feature of the software.
g) A process for authentication by the ordering physician – Typically, this is addressed by the vendor’s software.
There are vendors that provide secure text messaging solutions. A hospital may want to conduct a comparative assessment of the vendors in their market and the functionality offered by each. It is important to look at whether a product meets the hospital’s needs, including the needs of its health care practitioners and patients.
Other factors to consider that may influence a hospital’s decision related to a text messaging product include:
the hospital’s current technology infrastructure;
the ability and need for integration with the hospital’s existing systems or need for a stand-alone system; and
any local regulatory requirements.
Support needed for resources and decision-making regarding a secure text messaging platform are provided by hospital leadership, as required in GLD.7, ME 4. Leadership is responsible for ensuring direction, support, and oversight of information technology resources.