While bring-your-own-device, or BYOD, is commonplace in hospitals and healthcare organizations, sending unsecure text messages could be a costly mistake. Fines for a single HIPAA violation typically amount to $50,000 and could reach $1.5 million for repeated violations, according to the U.S. Department of Health and Human Services.
The adoption of BYOD programs is likely to continue as clinical workflow improvements that save time are more in demand than ever. Although HIPAA guidelines dictate that text messages should be sent securely, clinicians will likely use SMS text messaging if there aren’t alternatives in place.
By Rod Moore, Contributing Writer
Hoag Memorial Hospital Presbyterian provides secure text messaging to 1,500 physicians to streamline communication and discovers added savings after rollout.
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While bring-your-own-device, or BYOD, is commonplace in hospitals and healthcare organizations, sending unsecure text messages could be a costly mistake. Fines for a single HIPAA violation typically amount to $50,000 and could reach $1.5 million for repeated violations, according to the U.S. Department of Health and Human Services.
The adoption of BYOD programs is likely to continue as clinical workflow improvements that save time are more in demand than ever. Although HIPAA guidelines dictate that text messages should be sent securely, clinicians will likely use SMS text messaging if there aren’t alternatives in place.
According to a May 2013 Telemedicine and eHealth study, of 97 pediatric hospitalists, 60 percent admitted to sending texts, 61 percent had received texts, and 12 percent sent or received messages more than 10 times per shift. Almost one third received PHI within the text, and 46 percent confessed to security concerns with texting. Only 11 percent said their organizations had secure texting available.
Despite advances in areas such as health IT, U.S. hospitals still lose about $11 billion annually because of inefficient pagers, poor communication practices, and cumbersome communications processes, according to the Ponemon Institute.
A secure messaging platform is a challenge that Nhat Tran, M.D., chief medical information officer at Hoag Memorial Hospital Presbyterian (a 498-bed, not-for-profit, acute-care hospital in Newport Beach, CA), knows about firsthand. Fully accredited by the Joint Commission and designated a Magnet hospital by the American Nurses Credentialing Center (ANCC), Hoag Memorial is part of the Hoag Health Network, consisting of two acute-care hospitals, six urgentcare centers, and six health centers. Like doctors at many hospitals, physicians at Hoag were accustomed to texting other physicians about patients on a regular basis. But Hoag executives wanted secure messaging while streamlining communications and saving clinicians much needed time, since one of the problems Hoag encountered was a lag in response time when clinicians made requests for information from other clinicians.
Tran said Hoag’s biggest need was allowing physicians to continue to text each other, but to do it in a HIPAA-compliant fashion. “With the environment we live in now in terms of valuebased purchasing, there is a critical importance on efficiency and being cost-effective,” Tran said. Hoag planned to accomplish this by creating a more mobile workflow.
Assessing Messaging Solutions And Options
Although the primary problem was the lack of a secure texting platform, the hospital also did not have a clearinghouse for contact information for the entire Hoag network of 1,500 physicians who could be accessed through smartphones. Ultimately, Hoag formed a user group that investigated vendors and weighed their pros and cons. An enterprisewide secure messaging system called Tiger Text emerged as the clear winner.
Tran said one of the key reasons Hoag chose TigerText was that it could be quickly adopted because physicians were essentially preenrolled; all they had to do was download an app to their smartphones. “We deployed TigerText by enrolling all of our physicians at once,” Tran said. “Because part of the problem is if you tell 1,500 physicians, ‘We have a secure way for you to text each other, but you need to download this app, register, and pay a small fee of $6 a month,’ no one has the time and energy to do all of that.”
“At Hoag, we already have a clinical communications platform in place that we’re happy with, but two or three years ago its secure texting application wasn’t fully developed,” Tran said. “We performed our due diligence by looking at several players in the secure texting space. It can be difficult for many hospitals to justify the expense of any secure messaging application. They will always be looking for the return on investment, which can be difficult to show. But it’s more about physician time management and efficiency of care, both of which are invaluable.”
Because TigerText is a stand-alone application, Hoag didn’t encounter many obstacles during integration since none of the hospital’s home servers were involved. The only issue with the technology was that Blackberry devices were not supported by the time the rollout went into effect in May 2013, although only about five physicians were affected. (They have since migrated to other devices.) Tran also said Hoag chose not to integrate TigerText with its EMR since there wasn’t a seamless integration option with its EMR vendor.
Adoption Rates Exceed Expectations
Adoption rates with TigerText were unlike anything Hoag had seen before. Within three months, 45 percent of staff members were using Tiger Text. Now, more than 1,400 physicians have downloaded the TigerText app onto their cell phones.
“We track adoption rates in terms of how quickly physicians downloaded the app, and for an application that was entirely optional, the adoption rate was remarkable,” Tran said. “Our radiologists quickly discovered this app improved their workflow. Let’s say that a CT of a brain is performed and an intracerebral bleed is detected. In the past, the radiologist needed to call the ordering physician and wait for a reply. With TigerText, the response is much faster, and it’s terrific for patient outcomes because there is no delay in care.”
The app works similarly to SMS texting with several additional features, such as out-of-office notifications and automatic expiration, for example.
Another benefit of using TigerText is that it provides access to the entire database of Hoag physicians and clinicians who have registered the app. “With SMS texting,” Tran said, “I only had the cell phone numbers of 100 or 200 doctors. But now that practically everyone’s registered, I can text anybody on the medical staff, even if it’s an opthalmologist I’ve never met before, because if they’re on call and I need to ask a question, I can ‘TigerText’ them and receive a quick reply. So on top of HIPAA compliance, secure texting promotes and enhances physician communication and efficiency.”
Clinicians often prefer to receive important notifications via text since a text message can be less intrusive than a phone call. Additionally, with TigerText, physicians can choose to be notified when a text has been read.
“Our emergency department physicians also found benefit because if they have a patient requiring admission, they could quickly reach the admitting physician via TigerText,” said Tran. “This improved communication saves everyone time from playing phone tag, improves patient flow through the emergency department, and ultimately delivers better patient care.”
Surprise Savings Benefit
Although the primary benefit of TigerText was faster and secure messaging, after the initial rollout a surprise benefit was discovered when case managers began using the secure messaging system to navigate the time-sensitive Medicare/ Medicaid admission criteria. CMS’s admission criteria dictate that patients be admitted either as inpatient or observation status, but the designation must be completed during a specific window of patients’ being discharged. TigerText helps speed up the communication between case managers and physicians. Each designation pays very differently, so hospitals are motivated to identify patients as accurately as possible for proper reimbursement.
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“It is imperative that a patient’s level of care be as accurate and up to date as possible. Our case managers monitor this closely, and we made sure they have access to TigerText,” Tran said. “The benefit to the hospital isn’t just having the correct level of care, but this accuracy also decreases the probability of the infamous Recovery Audit Contractor (RAC) audits that every hospital is familiar with.”
With the success Hoag has had thus far, there are considerations to expand TigerText to other areas, including laboratory personnel, who would notify physicians of critical lab values. Tran also said if TigerText were to offer seamless integration with Hoag’s chosen EMR, it would certainly consider adding that functionality in the future.
While bring-your-own-device, or BYOD, is commonplace in hospitals and healthcare organizations, sending unsecure text messages could be a costly mistake. Fines for a single HIPAA violation typically amount to $50,000 and could reach $1.5 million for repeated violations, according to the U.S. Department of Health and Human Services.
“It is imperative that a patient’s level of care be as accurate and up to date as possible. Our case managers monitor this closely, and we made sure they have access to TigerText,” Tran said. “The benefit to the hospital isn’t just having the correct level of care, but this accuracy also decreases the probability of the infamous Recovery Audit Contractor (RAC) audits that every hospital is familiar with.”
