Text messaging adds considerations for EHR documentation

Dr. David Koronkiewicz, an orthopedic surgeon and former medical director of quality at Goshen (Ind.) Health, said he often sends texts via the health system’s secure messaging app during morning rounds.

The goal is to ensure other members of the patient’s care team are apprised of changes to the patient’s health, even if they haven’t read the progress note yet. “I can send a message to a provider and say, ‘OK, stable from an orthopedic standpoint to go home,’ ” he said. “He can see the quick little message and know the patient’s ready to go.”

But, while convenient, text messaging has raised concerns about physicians making care management and treatment decisions without properly documenting them in the EHR.

“The EHR is considered the source of truth, where people go to find information,” said Dr. Yaa Kumah-Crystal, assistant professor of biomedical informatics and pediatric endocrinologist at Vanderbilt University Medical Center, which is in the midst of rolling out a clinical communications app that allows members of a care team to exchange text messages about patient care. “You don’t want to create these silos of information, where there might be important discussion about treatment and management strategies,” she said.

Getting pertinent information into the patient record isn’t a new concern, said Andrew Selesnick, an attorney with law firm Buchalter’s healthcare practice group. Providers have been using phone calls, email and in-person conversations to communicate patient information for years, creating similar challenges.

There’s a growing number of apps that offer services for secure text messaging, providing care teams with a new avenue to communicate with one another almost instantaneously. They have the potential to help ease a notoriously inefficient system, allowing physicians to flag the most relevant information for their colleagues before digging through an often lengthy patient note.

To get relevant information into patient notes easily, Vanderbilt University Medical Center is looking into integrating its messaging service with the EHR, which Kumah-Crystal hopes will streamline workflows so that physicians don’t feel like they’re documenting information that’s recorded elsewhere.

Some EHR vendors offer their own secure chat tools, so that clinicians can discuss care decisions and document relevant information without needing to switch between systems.

NYU Langone Health has found that feature particularly useful, although it also means educating EHR users that the chat program is separate from documentation. Dr. Paul Testa, NYU’s chief medical information officer, said “Exchange of data is not documentation of clinical data.”

Health systems should consider whether text messages need to be printed and made part of the patient record in full, Selesnick said. Although that’s typically not required, it can be helpful for compliance and liability purposes. “Unless the communication is entered into the medical record, then for documentation purposes, it is as though it never occurred,” he said.