Electronic Health Reporter

Guest post by Ann Whitehead, RN, JD, vice president of risk management and patient safety, the Cooperative of American Physicians. 

Sending text messages has become a common method of communication among teenagers, adults, and more recently, medical professionals. Physicians are discovering that texting provides a quick and efficient way to communicate with colleagues, patients, and office or hospital staff. A recent survey by QuantiaMD of 38,000 physicians found that approximately “83 percent of physicians own at least one mobile device and about one in four doctors are ‘super mobile’ users who leverage both smartphones and tablet computers in their medical practices.”

As patients and healthcare providers increasingly use mobile devices to communicate with each other, concerns are raised about the security of electronic protected health information (e-PHI). The Health Insurance Portability and Accountability Act (HIPAA) Security Rule allows healthcare providers to communicate electronically with patients, but it also outlines standards to protect individuals’ e-PHI with appropriate safeguards to protect confidentiality, integrity and security of e-PHI. The following identifies security issues raised by texting of PHI between healthcare providers or provider and patient and how unsecure texting may violate the HIPAA Security Rule and create liability for healthcare providers.

As a general rule, texting of PHI by healthcare providers is strongly discouraged. Texting, or traditional short message service (SMS) messaging, is non-secure and non-compliant with HIPAA because data stored on personal mobile devices is not encrypted and is usually stored within the computer memory or on a smartphone SIM card or memory chip. The lack of encryption and the easily accessible storage methods allow any e-PHI communication on a mobile device to be retrieved and shared by anyone with access to the mobile device. This means that messages containing PHI can be read by anyone, forwarded, remain unencrypted on phone company servers, and stay forever on the sender and receiver’s phones.

Another reason why physician-patient texting is discouraged is that standard texting/SMS limits the message to 160 characters. This limited text field may cause critical information or options to be eliminated. According to a recent policy statement from the American College of Physicians and the Federation of State Medical Boards, physicians should understand text messaging is “not analogous to e-mail because of its abbreviated format and the greater possibility of missed messages.” Physicians are urged not to use text messaging even with established patients “except with extreme caution and with patient consent.”

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