Monday, November 30, 2009

Text Paging Health Information

I saw this in a recent nursing note:
Urine noted to be bloody without clots.
Text message sent to 2290 (trauma pager) about hematuria.
Patient denies any pain at this time.
No doubt patient identification or their room number, was sent to identify the patient (I'm not sure which). I suppose a record of the physician covering the trauma service that night is discoverable.

But I wonder, in the world of cyberspace with electronic communication carrying such an important role in health care delivery lately, is HIPAA really enforceable or will it just be used to extract huge fines from care providers now that the new HITECH policy expands HIPAA's reach.

Since text pages are neither encoded nor retained as an official audit trail of care delivered, it seems to me care providers are vulnerable, even when they are doing the right thing for the patient.



Darius said...

"text pages encoded"

can you elaborate on this? It's pretty easy to log text message content. what is 'auditable'?


DrWes said...


Although I am not an expert on this, conventional text messaging pagers send mesages that are not scrambled (encoded) using encryption technology. As such they do not comply with the HITECH Act that requires such. Also, the messages about a particular patient are not linked to a patient's record, leaving messages untraceable as to who it went to or if it was received. Certainly a log can be kept, but for how long? Who monitors this?

Are these things important? I don't know. But privacy advocates are concerned that sensitive patient health care information could be leaked through electronic transmissions and this seems one vulnerable area within the morass of health care IT where security has not been addressed to my knowledge.

Michael Kirsch, M.D. said...

I wonder if patients are already texting their physicians from their hospital beds. This would raise some interesting issues, particularly as the patient would have a record of the sent messages.

DrWes said...


Suddenly, with the scenario you describe, potential patient care communications would fall outside the medical record. Would you then have to maintain a log of that conversation? Yikes, this gets ugly fast...

I have had patients try to "friend" me on Facebook. To date, I have declined to accept their invitation - nothing personal mind you (they're nice people) - but separating personal from professional communication becomes virtually impossible. Might a "friended" patient perceive that a treatment decision was based on my social calendar commitments? I don't know, but really, I prefer to keep work and social life separate.

Michael Kirsch, M.D. said...

Thanks Wes,

Here's my take on the MD-Facebook issue.
Of course, technology and social media are unstoppable. But,they have trampled over a large measure of our professional ethos and style. In your own specialty, do the new folks coming out know what an 'opening snap' is, let alone be able to auscultate it?