San Joaquin General Hospital (SJGH) is a general acute-care facility located in French Camp, CA. The 196-bed facility provides the full breadth of inpatient services and is part of a larger medical campus that sees over 1,340,000 outpatient clinic visits annually. SJGH is somewhat unique in that it is home to education and residency programs almost as old as the hospital. These teaching programs include general surgery, internal medicine, family practice, and pharmacy. Don Johnston, CIO at SJGH, offers insight into how secure messaging at SJGH not only improved communication between clinician teams, but also became an integral part of the hospital’s education programs.
Compiled by Jennifer Dennard
Secure text messaging becomes an integral part of team care at San Joaquin General Hospital, finding its niche in several unexpected places.
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San Joaquin General Hospital (SJGH) is a general acute-care facility located in French Camp, CA. The 196-bed facility provides the full breadth of inpatient services and is part of a larger medical campus that sees over 1,340,000 outpatient clinic visits annually. SJGH is somewhat unique in that it is home to education and residency programs almost as old as the hospital. These teaching programs include general surgery, internal medicine, family practice, and pharmacy. Don Johnston, CIO at SJGH, offers insight into how secure messaging at SJGH not only improved communication between clinician teams, but also became an integral part of the hospital’s education programs.
Q: What drivers led you to start evaluating secure text messaging solutions?
A: In addition to being the CIO for SJGH, I also wear the hat of Chief Information Security Officer, so I am acutely aware of HIPAA fines incurred due to inappropriate use of standard texting platforms. I started looking into secure messaging technology to protect SJGH from these fines.
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I was also concerned with the issue of overhead noise and what secure texting could potentially do to improve direct communication between care teams. I had high hopes that we could save time by eliminating the need for many of our calls to have to go through an operator. We’re also a teaching facility, so we get a number of residents who are fairly fresh out of school and used to personal communication via text. I knew that we’d eventually need to offer that particular group a secure text messaging solution, especially in light of all the recent HIPAA fines.
Q: What criteria did you use to find a secure messaging solution?
A: From a HIPAA perspective, we needed to make sure the solution would run on cell phones and tablets. It also needed to work through standard browsers found either on a dedicated PC or a thin client running Citrix. I wanted something that would cater to the unit clerk or nurse sitting at a PC who might need to reach out via text to a larger group. I didn’t want them to have to break out a phone just to send a secure message.
From a security perspective, we wanted to make sure the text didn’t remain on the phone. I also wanted something that could integrate into our native Active Directory, so that users wouldn’t have to learn another username and password. Additionally, I wanted a cloud-based solution that offered the ability to set message expiration. It also had to support a distribution list that we could predefine. I wanted users to be able to send one-on-one messages, as well as one-to-many messages, even if they were outside of predefined distribution groups.
Finally, from an educational standpoint, we also wanted to make sure the solution had the ability to securely send attachments. This feature would allow our attending and precepting physicians to quickly send material to a wide audience.
Based on these criteria, we selected TigerText. We rolled out the solution to our trauma team first, which includes nurses and other ancillary support personnel. Their devices in the field work off a Wi-Fi signal or cell tower, both of which TigerText supports. This team quickly began to rely on it as one of their primary notification tools. We then got the solution into the hands of other staff members including physicians, nursing care manager teams, and case management staff. In total, we now have about 100 people using TigerText in a BYOD (bring your own device) environment.
Q: How does the solution work?
A: As with any texting application, the user decides to send a message to an individual or a group. They enter a PIN number to gain access to the application and are then presented with an interface that enables them to easily look up users and groups. They select the person or group they want to send a message to, type the message (or speak ![]()
it if using a speech-to-text enabled phone), and hit send.
On the back end, that message is authenticated against our active directory, which makes sure the text gets sent to the appropriate user at the appropriate number. The nice thing for us is that TigerText alerts users as to whether sent messages have been received and read. That’s a nice change from pager technology, which left users in the dark as to whether their page had been received until somebody responded to it.
Q: What are some unique texting needs in a hospital environment?
A: A regular enterprise environment doesn’t have to worry about HIPAA regulations. A hospital does. HIPAA is a broader class of how we can get into trouble. If a doctor has a picture of a patient on their phone, and that picture happens to mention a name, you’re guilty — no ifs, ands, or buts. That doctor might not know that person individually, but that’s enough to incur a HIPAA violation.
Luckily, we don’t have to worry about HIPAA violations with our secure text messaging solution. Messages are encrypted so patient privacy is protected. Also, if a user loses their cell phone and it can’t be remote wiped, there is no plaintext PHI actually stored on the mobile device. Texts are sent as a data packet rather than typical SMS or MMS (multimedia messaging service) data, and these packets are encrypted.
Q: How far do you take text communications? Why?
A: We’ve extended texting a lot because of the way we use it in support of our educational program. For example, we’ll text residents a problem of the day with a deadline for a recommended course of treatment. TigerText makes that easy with its ability to securely send attachments ![]()
such as word docs, PDFs, and images.
SJGH also has a strong relationship with the California Department of Corrections and Rehabilitation (CDCR). We are a designated acute-care hospital for several prisons in northern California, so there are often team care messaging scenarios around hospitalized prisoners. Secure text messaging comes in handy especially during discharge, when various workers need to remind other team members to have particular kinds of paperwork ready. There are specific processes to follow when discharging a CDCR patient, and so texting makes it that much easier to send HIPAA-compliant reminders amongst care team members.
Q: What benefits have you seen as a result of secure texting?
A: It’s made life easier because it allows me to quickly deploy IT staff to certain spots in the hospital. It also makes it easier to reach out to subgroups, an entire team, or individuals, whether they’re at the hospital or not. That ability to quickly reach targeted groups of people is especially important in our role as a first-responder coordinator hospital for San Joaquin County.
We’ve also seen a reduction in overhead noise as a result of using secure text messaging, which has certainly been a nice benefit. That reduction, coupled with improved staff responsiveness, has helped improve our patient satisfaction scores.
An audit trail has been another benefit. When we used pagers, we’d have interesting conversations about whether pages were ever received. TigerText gives us an audit trail that tells us if and when the user opened their phone and read the message.
Q: Does SJGH plan to expand its use of secure text messaging?
A: Yes. We’re looking at a TigerText solution right now that will enable it to be directly accessible from the EMR or incorporated into our sign-off technology. A lot of the health IT systems we use have API (application programming interface) capability to connect to another platform, so we think it would be great for productivity if our staff could use TigerText from within those systems rather than having to open up another window just to launch it.
San Joaquin General Hospital (SJGH) is a general acute-care facility located in French Camp, CA. The 196-bed facility provides the full breadth of inpatient services and is part of a larger medical campus that sees over 1,340,000 outpatient clinic visits annually. SJGH is somewhat unique in that it is home to education and residency programs almost as old as the hospital. These teaching programs include general surgery, internal medicine, family practice, and pharmacy. Don Johnston, CIO at SJGH, offers insight into how secure messaging at SJGH not only improved communication between clinician teams, but also became an integral part of the hospital’s education programs.
I was also concerned with the issue of overhead noise and what secure texting could potentially do to improve direct communication between care teams. I had high hopes that we could save time by eliminating the need for many of our calls to have to go through an operator. We’re also a teaching facility, so we get a number of residents who are fairly fresh out of school and used to personal communication via text. I knew that we’d eventually need to offer that particular group a secure text messaging solution, especially in light of all the recent HIPAA fines.
it if using a speech-to-text enabled phone), and hit send.
such as word docs, PDFs, and images.
