Is Texting legal

[shbryer]

One of the Doctors where I work does not like to be called and will text nurses his orders. He want the nurse to text him what ever is the problem - Like --Mr Jones in 234 had a fall and hit his knee and his head. He is bleeding from the cut on his head. I do have a problem with this as several times he will text a nurse off duty and she calls the hospital to relay the message. I complained to the DON but since he is the medical director he gets it his way. I want to know if I am right. I feel this has to be a HIPPA violation at the very least.

[NurseForChange]

I would believe that if your employer is not paying for your cell phone, then they do not have the right to use texting as a means to relay orders. As for taking orders from an off duty nurse, who the Dr. "texted" IS VERY FISHY, who knows if that nurse got the correct order for the correct patient? and who is to say the Dr. got the correct patient, and ALLWAYS COVER YOUR OWN BUTT, because if the Dr. messed up, the blame will be sure to fall down to the nurse... with a transcription error.

[voraciousj]

So what happens if you are at home, off duty and your phone is turned off? Or you're away from it and don't receive an important test regarding orders? Who is at fault then for a bad outcome?

That is a bad idea all around.

[cookienay]

This practice is most likely in violation with the read back and verify standard set forth by JCAHO. How does he get all of your personal cell nubers?? At the very least I would keep my cell in my locker, car, purse at work and force him to call in his orders. But that is just me.

[NRSKarenRN, BSN, RN]

from today's hospitalist., february 2009

the brave new world of electronic communications

just last winter, the hospitalists at university hospital in ann arbor, mich., wrote down patient orders the old-fashioned way, scribbling them onto three-ply carbon paper and distributing them to nurses, pharmacists, and x-ray and lab technicians.

now, the hospital has come of age by adopting a computer physician order entry (cpoe) system. instead of carbon copies, the hospitalists use desktop or laptop computers to order drugs and tests online.

the cpoe system, implemented last april, has received an overwhelmingly positive response from physicians and physician assistants. but it has required some readjustment and fine-tuning.

within two weeks of the system going live, for example, nurses at the ann arbor center were calling meetings to discuss some of the fallout from the new system. the problem? because communication had been largely automated, their interactions with physicians had been sharply curtailed.

in the past, nurses paged doctors, who would then call back to discuss drug orders and other requests. after the new system went live, however, physicians who received a text page would simply fill the order at the closest computer. because physicians no longer had to return calls before placing an electronic order, the nurses complained that they were no longer sure whether orders were being filled.

while the snags that the hospital encountered were relatively minor, they illustrate an overlooked reality of high-tech systems. while the technology can boost efficiency and improve patient safety, it can also change the way hospital personnel--physicians, nurses, case managers and social workers--interact around patient care...

wireless text messaging

new technologies for wireless text messaging

when messages are sent via e-mail as clear text from a telemessaging call center, they are extremely vulnerable as they traverse the internet. as the text messages are transmitted over the air in clear text, they can also be easily intercepted and logged. this vulnerability is all the more important given the privacy issues raised by hipaa...

[chenoaspirit, ASN, RN]

And what if a cell gets stolen or lost, the doc would unknowingly text private info. No one keeps their cellphone on their hip at all times, what if it doesnt get deleted and someone picks up that phone and reads it. Who pays the bill on all those texts? There are just too many issues with texting patient info. I wouldnt be comfortable with it. If I were off duty and I received a text order, I would be ticked off. I would have to be the one to write the order since I was the one who accepted it. I would NEVER use my PERSONAL cellphone or work business. If they want me to use a cellphone, they will provide me with a company one. Can you anonymously let his superior know whats going on? That way your repuation would not be damaged and maybe then they will stop this from happening. No way would I be comfortable with that. If a MD has time to text, he has time to call.

[HeartsOpenWide, RN]

I would have a problem with a doctor that does not have the common decency to pick up the phone and check up on his patients are call to give an order...as it is TORB are suppose to be for emergent situations...texting seems even worse! And what are the privacy features of these phones? I sent a text to my neighbor the other month and got a rely back from a number out of my area code..."who is this?"...after some back and forth texting with a stranger it was determined a copy of my text was randomly sent to some guy in TEXAS...I am in CALIFORNIA...

[chenoaspirit, ASN, RN]

So what happens if you are at home, off duty and your phone is turned off? Or you're away from it and don't receive an important test regarding orders? Who is at fault then for a bad outcome?

That is a bad idea all around.

Exactly! There is no way to ensure that a text is received.

[BabyLady, BSN, RN]

I know that legally, there is no right to privacy regarding text messaging. It's a form of communication so insecure that we don't have a right to expect it to be private. If law enforcement can look at it without a subpeona, it's too insecure for medical communication IMHO. I like the idea of saying you don't have a mobile phone. Change your number and don't share it with him! The whole thing is just bad form!

I personally don't believe that such a thing is even necesssary.

I would have no problem telling a Nurse Manager or a physican that my cell phone is ONLY for friends and family and not for work.

No way would I take the responsibility of a physician sending me a message off duty and then having to drop everything I am, make sure I have a signal or find a phone to call the order in AND have to worry about getting it accurate.

It's a problem waiting to happen...as well as a lawsuit.

If I was sitting on the jury, no way would I accept a physician's "But I sent it!" as an excuse.

[Chapis]

not everyone has texting in their plan, like me, so just tell him you don't have or can't text or receive text messages.

[luvschoolnursing, LPN]

I personally would rather speak to someone if I am describing something as serious as a change in a patient's status or lab values. For one thing, sometimes I don't always double check when I use t9 and my words arn't quite what I want them to be. also, I would rather you hear the concern in my voice and allow me to describe conditions if you didn't quite understand me. Sounds all around unsettling to me. Maybe I'm just old...

[caliotter3]

I also agree that the way to handle this is to change your cell phone number and start telling your job that you no longer have a cell phone. They can not force you to provide a cell number unless they provide you a phone, pay for it, and then give you instructions on what it is to be used for.

I do not have a texting plan and resent it when I have to pay for unsolicited incoming spam messages. Recently I got a garbled message. It had a date on it for February 2010 and included the name of someone that might have sent me a text message. I saw no need to follow up on it and assumed that it was sent to the wrong number. I can't say about the garbling. But that certainly points out that texting is definitely no guarantee of accuracy. If it were me, I would not engage in this practice. The doctor is taking chances. But I guess he feels secure with what he is doing.

[CathyLew]

you better have a policy that says its ok