In brief
- While convenient and quick, texting personal health information among healthcare professionals presents medico-legal risk for physicians because the content of text messages may be disclosed as evidence in civil, College, or hospital proceedings. 1
- Physicians should be familiar with their College’s requirements for protecting personal health information.
- Healthcare teams can engage strategies to maintain patient confidentiality, support clear communication, and prevent potential negative perceptions.
Privacy and confidentiality
Privacy legislation and confidentiality obligations require physicians to safeguard patient information from theft, loss, and unauthorized use or disclosure. These requirements extend to text messaging and other electronic communication channels.
Texting patients’ identifiable personal health information may lead to a privacy breach. Depending on the province or territory, it may be necessary to report a privacy breach to the affected individuals (i.e. patients), the privacy commissioner, your regulatory authority (College), or possibly all three.
Your device is not encrypted, or the WiFi or wireless network is unsecured.
- Familiarize yourself with your College’s requirements for protecting personal health information (PHI). In Ontario, for example, physicians must use encrypted e-communication when communicating PHI to other healthcare providers, unless there is an emergency or other circumstance that requires the use of unencrypted e-communication.
- Consider secure alternatives to texting, such as an instant messaging application that encrypts data transfer. Your hospital or health authority may advise on an approved app in your facility.
- Alternatively, omit identifiable patient information, or use texting only for routine tasks such as setting up an appointment or requesting a phone call.
A message is sent to multiple recipients, including those outside the patient’s circle of care.
- When texting as a group (among multiple parties), ensure all recipients need to know the information (i.e. are they part of the patient’s circle of care?).
A message is sent to the wrong recipient.
- Use your contact list to send a new message (to avoid entering recipient information each time).
- If you discover that you inadvertently sent a message containing patient information to the wrong person, notify that person of the error and request that they delete the message.
Your office staff use their personal devices to communicate patient information with you.
- Develop policies and training on privacy requirements, including prohibiting the use of personal devices to communicate patient information.
- Have staff sign a confidentiality agreement that stipulates their responsibilities to safeguard personal health information.
Your device is lost or stolen.
- Ensure your device is password-protected.
- Use encryption on your device.
- Contact the CMPA for advice on any privacy reporting obligations.
Clear communication
Texting can present challenges for clarity of communication. As well, text messages may be disclosed as evidence in civil, College or hospital proceedings. As with medical records, Colleges expect that communication via text messaging and other electronic channels is clear and professional.
A text message contains abbreviations and unclear, cryptic language, increasing the risk of miscommunication.
- Avoid texting about complex issues that require lengthy explanations.
- Write out words in full, avoiding all but the most common acronyms and initialisms.
Auto-correct has changed words as you type without you noticing.
- Read the message carefully and make any needed corrections before tapping Send.
- If feasible, disable the auto-correct feature.
You provide your professional opinion on a clinical case via text, possibly in the place of a consultation letter.
- Treat text messaging as you would a corridor consult, a formal written consult note, or a consult conversation via phone or email.
- Document your advice as per your usual practice.
- Continue to use consultation letters as appropriate, thereby facilitating documentation of your advice.
You haven’t received a reply to a question.
- Don’t assume the recipient has received or read or has the time to respond to your message.
- Consider following up on time-sensitive matters verbally.
- Upon receiving and reading a text message, practise good team communication by closing the loop: Reply to the message, acknowledging receipt and any actions requested.
You provide your professional opinion, but are not familiar with the patient or the clinical history.
- Assume that the content of the text exchange would be deemed a consult. If needed, seek clarification and more details, and suggest a discussion by phone or in-person.
- When you offer a clinical comment or opinion that you know others will likely rely on to make decisions about a patient’s care, you might be found to owe that patient a duty of care—even if you never met the patient.
You don’t know where to document your advice
- If feasible, capture all relevant text messages (e.g. using screen captures) and add these to the medical record.
- When this is not possible, summarize the text exchange and document the summary in the medical record. Some hospitals may have policies or protocols for documentation in these circumstances.
Perceptions of professionalism
Texting typically lends itself to a casual style of communication that may be seen as unprofessional. Additionally, face-to-face interactions with patients or other care providers might be disrupted when engaged in a text conversation.
You tend to fall back to a casual, unscripted style of writing.
- Do not write messages containing inappropriate language or in a tone for which you could be later criticized for lacking professionalism.
A text message contains sensitive information (e.g. mental health or sexual issues, alarming test results).
- Some subjects may be inappropriate to discuss via text messaging, even if the proper information security protocols are followed. Suggest to the other party that the matter might be better discussed verbally by phone or in-person.
You receive a text message while speaking with a patient or healthcare colleague.
- Unless the text exchange is urgent, avoid looking at your device to read the message; resume texting when time permits.
Additional reading
Note
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Text messaging, or texting, refers to composing and sending electronic messages via smartphone, tablet, or computer. It refers to messages sent using the short message service (SMS) that is associated with a mobile network, or through a texting app linked to the Internet.
