Texting? Weigh Your Options

By David Brooks, Co-Founder & Executive Vice President of Market Strategy, qliqSoft, Inc.

For the health care professional, texting represents a simple choice between doing either what is immediate but risky, or what is deliberate yet secure. Expressing it any other way is overcomplicating the issue.

SMS text messaging is the most widely used data application in the world. Last year alone, more than 7 trillion SMS messages were sent worldwide. It’s just about as pervasive and widely used as oxygen. And for some, e.g., teenagers, it’s nearly as important.

The appeal is pretty clear: it’s portable, convenient, always on, immediate, and reliable. In technical parlance, it’s “asynchronous”, which is that wonderful characteristic that allows us to communicate on our terms. We can respond when we’re ready, or not at all. We’re not trapped. In other words, it’s pretty much the perfect communication tool for an increasingly mobile and schizophrenic society.

Unfortunately, where health care is concerned, it’s also unsecure. If you use it in a professional capacity, you cannot text sensitive protected health information (PHI). If you do, you’re violating HIPAA and HITECH privacy and security regulations. It’s that simple.

Yet, anecdotal evidence suggests that SMS texting is common, if not rampant, across health care. Does this suggest people are flagrantly violating government regulations?

Before answering that, it is worth providing some context to the question. Health care has long been plagued by communication challenges. For example, lack of communication is frequently cited as a major contributing factor or root cause of preventable medical errors. The Institute of Medicine identified the issue in its seminal 1999 report “To Err is Human.” Separately, The Joint Commission has consistently identified poor communication as the root cause in over two-thirds of all sentinel events in all annual reports conducted from 2004 through 2011.

Would it, therefore, be surprising for health care professionals to seize the greatest advent in communication since perhaps the telephone itself to improve clinical care? It shouldn’t be.

Not so long ago, millions of people used the file-sharing service Napster to download MP3 files from across the Internet. The technology revolutionized digital media and ultimately paved the way for iTunes. In the process, it also cost the record industry billions of dollars. Few, if any, downloading music via Napster could honestly deny that they were committing copyright infringement. Does this mean we are all inherently law-breakers? I don’t think so.

A far more likely explanation is that people, en masse, recognized technology had outpaced our ability to manage the rules and policies surrounding it. So, instead of simply abstaining from the technology, we tacitly agreed not to ask ourselves too many hard questions, choosing to embrace the technology until an acceptable alternative presented itself. In the case of MP3s, iTunes eventually replaced Napster. Songs soared in price from nothing to 99 cents a song, and just about everyone was happy to pay it. Relieved, in fact.

We now have a similar opportunity where texting is concerned. A couple of companies, including qliqSoft and TigerText, offer secure texting solutions specific to the health care industry. More accurately described as “secure messaging solutions,” these applications create a similar, if not enhanced, texting experience but using alternative technologies to SMS. These health care-focused solutions specifically address the three critical requirements either directed by HIPAA or suggested by The Joint Commission in a statement issued last November concerning texting orders – authentication, encryption, and auditability.

As with iTunes, there are some hurdles involved in adopting the technology. With SMS, nearly everyone already has the capability installed on their phone. It is ubiquitous. As long as you know someone’s mobile number, you can send them an SMS. But purpose-built health care solutions require users to download and install apps on their phones. It then requires their contacts to do the same before any secure communication can begin. It’s unavoidable.

However you decide to proceed, understand that you do have options. With SMS text messaging, you can:

  1. Abstain altogether;
  2. Omit PHI and text cryptically;
  3. Text openly and hope it doesn’t become a problem (three “solutions” that are probably not ideal) or;
  4. With a little effort, you can install a secure messaging solution and text freely, without worry.

David Brooks is co-founder and EVP, Market Strategy, at qliqSoft, Inc. He has worked within the mobile health space for the last 12 years, both as an independent consultant and an entrepreneur. In addition to key consulting engagements, ranging from assisting a major wireless carrier’s mHealth strategy to supporting IBM’s Nationwide Health Information Network (NHIN) prototype project, he has also written numerous articles and publications. Among other accomplishments, David was a core member of the team that started mobile health pioneer MercuryMD, which was acquired by Thomson Financial in 2006.

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