Jessica Kim Cohen October
19, 2019 01:00 AM
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.
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