Was order texted? Patients are at risk
While a resident was entering an order to discontinue warfarin, she was distracted by an incoming personal text message that interrupted the order, and the patient continued to receive the drug for three days.1
The patient required emergency open heart surgery, which the team members thought was due to spontaneous bleeding into the pericardium from receiving the extra doses of warfarin.
"Today's young physicians often text while doing care-related tasks. I would encourage clinicians to avoid personal texting entirely while delivering patient care," says John D. Halamka, MD, MS, chief information officer of CareGroup Healthcare System in Boston and associate dean for educational technology at Harvard Medical School. "All our ordering systems are web-based and accessed via a secure https session. We do not support texting in any clinical context, because it is not secure nor auditable."
There are emerging products in the marketplace such as TigerText (http://www.tigertext.com) that enable healthcare organizations to host secure texting systems within their firewalls, notes Halamka, but CareGroup has not implemented such products. "Given that provider order entry via a certified EHR [electronic health record] is a requirement of meaningful use, I see no role for texting in ordering processes," he says.
Here are some liability risks involved with texting orders:
• There is no way to verify that the intended recipient actually received, or acted on, the order.
Paul A. Anderson, director of risk management publications for the Plymouth Meeting, PA-based ECRI Institute, a nonprofit organization that researches approaches to improve patient care, says, "The intended recipient's phone could be off or not able to get a signal, or the recipient could just ignore the phone because they're in the middle of some other task."
• Because medical terms and abbreviations are unlikely to be in a smart phone's dictionary, these may be autocorrected.
"If the ordering physician doesn't notice the change, it could change the message into nonsense and delay care," says Anderson. "Or it could introduce a clinically significant error, leading to, for instance, a wrong drug being ordered."
From the point of view of the person receiving the order, there's no way to verify that the person sending the order is who they say they are, he adds. "The risk here is that someone who's not authorized to do so sends in orders, whether that's some third party using the physician's phone, or, less likely, some third party 'spoofing' the physician's phone to impersonate them," says Anderson.
Technological solutions are being developed by EHR providers and other vendors to address identification and verification issues for texted orders, notes Anderson. "Before implementing any of them, a physician practice should ask to speak with references who have implemented it and should put the system through its paces to assess how it handles these risks," he recommends.
Key questions to answer are: How easy is it to send the order to the wrong person? Does the text sync with the medical record appropriately? Can you confirm that the recipient received and acted on the order? "In the absence of such a solution, texting really should be avoided," says Anderson, noting that there could conceivably be an emergency situation in which texting is the only available form of communication and the risks are outweighed by the need to supply the order immediately.
"In general, though, even a verbal or telephone order is preferable to a texted order," he says. "In those scenarios, at least the two parties have an opportunity to interact and ask questions. Both parties know that the other is listening at that moment."
Reference
- Agency for Healthcare Research and Quality. Cases & Commentaries: Order interrupted by text: Multitasking mishap. December 2011.
Sources
For more information on liability risks of texting orders, contact:
- Paul A. Anderson, Director, Risk Management Publications, ECRI Institute, Plymouth Meeting, PA. Phone: (610) 825-6000, Extension 5244. Fax: (610) 834-1275. Email: [email protected].
- John D. Halamka, MD, MS, Chief Information Officer, CareGroup Healthcare System, Boston. Email: [email protected].
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content