The Joint Commission clarifies stance on secure text messaging of patient care orders

Communication is an essential component of the safe and effective practice of medicine and, in particular, surgery. In today’s digital age, communication takes place across various platforms.

A 2015 study by the Pew Research Center showed that nearly two-thirds of Americans (64 percent) own a smartphone, and that text messaging is the most widely used feature on these devices.* In the 18–29-year-old demographic, nearly 100 percent of the respondents said they used their smartphones for text messaging, whereas nearly 98 percent of respondents ages 30–49 said they use their phones to text message.

Texting in health care: The debate continues

Texting may be a popular and effective way to communicate with friends and family, but in recent years The Joint Commission and other stakeholders have debated its appropriateness in the health care environment. In May 2016, The Joint Commission acknowledged advancements that have resulted in enhanced security for text message data. As a result, The Joint Commission revised its previous position that advised against secure texting of patient care orders and decided to allow licensed independent practitioners (LIPs) to use secure text messaging platforms to send patient care orders, provided the systems met certain criteria.

However, after concerns were raised about security issues related to transmitting orders via text in December 2016, The Joint Commission, in collaboration with the Centers for Medicare & Medicaid Services (CMS), decided to reverse its May 2016 position to allow secure texting for patient care orders and issued the following recommendations:

  • All health care organizations should have policies prohibiting the use of unsecured text messaging, also known as short message service, from a personal mobile device for communicating protected health information.
  • The Joint Commission and CMS agree that computerized provider order entry (CPOE), which refers to any system in which clinicians directly place orders electronically, should be the preferred method for submitting orders, as it allows providers to directly enter orders into the electronic health record (EHR).
  • In the event that a CPOE or written order cannot be submitted, a verbal order is acceptable on an infrequent basis.

The Joint Commission decided that the use of secure text orders was unacceptable for a number of reasons. One concern raised in discussions with CMS was that text messaging of orders would place an increased burden on nurses. If more providers texted patient care orders, nurses would have to enter those orders into the EHR manually, which would add time and could lead to the introduction of errors. Another concern centers on the challenges this technology presents regarding detailed conversations. As the patient care order becomes more detailed, a conversation becomes more necessary—for example, a discussion regarding how medication might interfere with other prescriptions. Because text messaging is not integrated into the EHR system, crucial information could be overlooked.

Another reason The Joint Commission issued the new recommendations on text messaging is the possibility of a clinical decision support alert during the order entry process into the EHR, when the individual keying in the order may need to contact the ordering health care professional for more information. When the information is communicated verbally, the clarification is immediate, whereas an order by text could potentially face delays.

The Joint Commission will continue to monitor how advancements in technology shape this issue and will continue to consult with key stakeholders to determine how best to address the issue in the future. Any questions regarding text orders and The Joint Commission’s stance can be e-mailed to


The thoughts and opinions expressed in this column are solely those of Dr. Pellegrini and do not necessarily reflect those of The Joint Commission or the American College of Surgeons.

*Pew Research Center. U.S. smartphone use in 2015. Pew Research Center American trends panel experience sampling survey, November 10–16, 2014. Available at: Accessed January 20, 2017.

Joint Commission Resources. Update: Texting orders. Perspectives. May 2016. Available at: Accessed January 12, 2017.

Joint Commission Resources. Clarification: Use of secure text messaging for patient care orders is not acceptable. Perspectives. December 2016. Available at: Accessed January 12, 2017.

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