Over the last three years, FOAMcast listeners have come to expect our podcast to serve as a bridge between the cutting-edge progressive emergency medicine practice favored by free open-access medical education (#FOAMed) blogs and podcasts and the real world of everyday medicine and core content that we all practice most of the time. To that end, our four most recent shows are excellent examples of that bridge. Check them out on iTunes or at FOAMcast.org.
Here’s a quick rundown.
First up, text messaging during clinical care. I text. You text. Your kids text. Your brother and your mother text. Your patients? They definitely text, often during the physician encounter. Let’s face it: We all text. In fact, 91 percent of all Americans have a cellular phone, and of those, 81 percent report use of text messaging.1
What about doctors? The numbers vary, but according to research cited in an essay written by plastic surgeon Brian Drolet, MD, at the Center for Biomedical Ethics and Society at Vanderbilt University Medical Center in Nashville, studies have found that 60 to 80 percent of physicians text for the purpose of communicating in the context of clinical care.1 The first question is whether using texting (officially known as “short message services,” or SMS) is legal at all.
The good news is that, yes, using texting for communicating medical information with other providers involved in the care of a patient is legal, provided that we are careful. Surprisingly, “being careful” doesn’t only mean that we must use encrypted texting software for these endeavors. In fact, a truly secure and fully encrypted texting platform that physicians can rely on simply does not exist. Long story short, we can use normal text applications on our smartphones, provided that we take precautions in addition to following the normal HIPAA rules. Here are some pointers:
- Protected health information (PHI) must be deidentified.
- A patient’s name (even initials) must not appear in a text.
- Mistakes are possible if, for example, you are texting with a consulting service who is following more than one patient in your department.
- Extra care must be taken, and follow-up phone calls often are advisable.
- A patient’s medical record number should also not appear in a text.
- May physicians text photographs of clinical information to one another? Yes but, again, with precautions. For example, a picture of an ECG may be texted to a cardiology consultant as long as PHI does not appear in the photograph. Even photographs of rashes can be texted, assuming you can find a dermatologist who’s interested.
- Make certain that the patient can’t be identified by the photograph. This means, for example, zooming in on rashes that appear on the face to protect the patient’s privacy.