CMS Update: Texting Patient Orders in Healthcare

CMS Texting Patient Orders Announcement

The Centers for Medicare & Medicaid Services (CMS) recently issued a significant quality standard memo regarding the practice of texting patient orders:

• This update grants providers at hospitals and critical access hospitals the ability to transmit text orders through secure messaging platforms, all while maintaining compliance with the medical record Conditions of Participation (CoPs).
• This is a reversal of prior guidance issued by CMS in 2018, which maintained CPOE as the only acceptable method of order entry.

In their memo, CMS indicates that CPOE is still a “preferred method of order entry,” but the agency also recognizes that “alternatives also exist now, as well as significant improvements in the encryption and application interface capabilities of texting platforms to transfer data into electronic health records.”

The Joint Commission also confirmed that the use of secure text messaging for patient orders is “currently under review.”

What Healthcare Leaders Think of the CMS Texting Patient Orders Update

To dig deeper into this important news, we hosted a roundtable discussion on March 7. In this webinar, two members of PerfectServe’s leadership team were joined by three industry experts to discuss the implications of CMS’s policy shift.

Panelists included Amanda Brown, Vice President of the Nursing Workforce and Professional Practice at Baptist Health; Tracey Moffatt, Internal Senior Executive Consultant at Ochsner Health; and Dr. Eric Eskioglu, Physician Executive and Senior Partner with Csuite Growth Advisors.

They covered what the potential impact will be on care team communication and patient care, breaking the discussion into three key areas:

1. The likelihood of adoption across health systems
2. The impact of texting on speed to care and the efficiency of care delivery
3. The impact on patient safety

Likelihood of Adoption

Dr. Eskiolgu spoke about changes that could be made to current workflows to yield potential new workflows. Currently, most providers can input orders at their desktop, including verbal orders from a nurse’s request. In emergencies, this can lead to errors, both on the nurse’s side and the physician’s side. Dr. Eskioglu thinks that texting orders could help to mitigate errors, because the request would be written out visually. In that vein, health systems may adopt these guidelines to help limit human error.

He thinks the biggest challenges with adoption will be with the bylaws and the regulatory bodies themselves, as well as the increased burden it could put on nurses. Though he believes the technology we have today can facilitate the texting of patient orders very well, he thinks there will be regulatory hurdles to get through, such as the different workflows each health system already has in place and how those will impact what they can and can’t change in their current communication protocols. Each health system, Dr. Eskiolgu said, will have to “look at their appetite” for adopting changes, as no two health systems are exactly alike.

Tracey believes that most health systems will implement these guidelines sooner or later, but she wants to make sure it’s done with a central focus on why we’re all in healthcare in the first place: patient care.

“I think there’s a high likelihood that ultimately most healthcare organizations will adopt more texting of position orders or provider orders,” Tracey said. “I think that [texting orders] can help speed the process along. And if we keep the patient at the center of the decision making and design process, the patients will be better protected and will receive more timely and efficient care.”

Amanda also believes that many health systems will adopt these new guidelines, but not without undergoing a deliberate policy change process. Her main concern focuses on what components make a complete order that meet the CMS Conditions of Participation, and how those will be monitored.

Speed to Care and Efficiency

Regarding care delivery and whether texting orders will improve efficiency, Amanda can see both the pros and the cons. Doctors and nurses are always “trying to facilitate patient flow and put out fires,” so on the one hand, being able to stay mobile and pend an order via text could save time and speed up care delivery. However, with phones being the new go-to for texting orders, she worries about how that will change expectations about how quickly a provider should respond and what will dictate the level of response based on the patient’s need.

“I worry about a little bit about the expectations of, when I send a text, it’s going to be received immediately as if it’s on their personal device,” Amanda said. “We have to leverage the technology we have and decide what’s interruptive, what’s not interruptive, what can wait? I think some of those simple things that also meet patient needs right away … I think that can help us meet patient needs a lot faster. I think that’ll help nurses’ speed and efficiency because a lot of times, we know what the next step is going to be.”

Dr. Eskioglu was quick to remind listeners that speed shouldn’t be the only consideration—what’s important is the overall quality of care. When it comes to the speed of care delivery, his concern with texting is not having “the full clinical picture in your hands.” What if, for instance, a texted order is missing important information? His advice to each organization is to run a study to see how, when, and where texting orders could work.

“Run a pilot study in an environment where you can control [texting orders] in a lower acuity unit, and see how the results are compared to previously,” he said. “You can see it from the serious safety events, and you can see it with medication management.”

Tracey touched on the processes that would define how providers should use the new guidelines with communication processes that are already in place. For example, the hospitals within her health system use various secure messaging platforms. How will these existing tech systems fit into a texting workflow, and what modalities might change based on what the CMS guidelines define? But despite the initial challenges, she remains sure of one thing: When done correctly, being able to text patient orders will make care delivery more efficient.

Patient Safety

Patient safety is at the forefront of all clinical communication decisions, and that very much includes these new CMS guidelines. Amanda brought up the point of distractions and how they might impact a patient’s level of care and their health outcomes. She asked a series of questions about why you might opt to text a patient order versus the traditional CPOE method.

“Why are you texting the order while you were otherwise engaged in a different activity? Can you be focused on this patient in this order? There’s a reason you can’t get to a computer or pick up a phone to address this patient. Are you listening? Half listening, half not listening?” Amanda asked.

She also thinks that the ability to get clarification on an order is a critical aspect of how texting orders could impact patient safety. As long as guidelines are put in place to allow for follow-up to get more information, this could potentially benefit patient safety. It will ultimately come down to the quality and clarity of the order.

Tracey agreed and said that orders could drastically slow down if texted orders are incomplete. This again brought up the need for more guidelines and recommendations for what constitutes a complete order, what forms or attachments might be included in a texted order, and how those orders are received and escalated. Nurses, then, must be included in all conversations about guidelines for texting of patient orders, as they are critical cogs in the care delivery and patient safety wheel.

“That’s where the judgment of a professional nurse is critical in the process,” Tracey said. “Nurses should be at the table when the process is designed. I think of nurses as the recipients of these orders, and […] they really need to be around the table and have this thoughtful discussion.”

Dr. Eskioglu touched on the place of voice-to-text transcription and autocorrect in this process and how not having double- and triple-checking parameters in the order process could be detrimental to patient safety. For example, if a patient has an allergy to a certain medication, will that be included in the texted order? What would happen if a provider used the voice-to-text feature to “write” the order in their phone, but there was a mistake in the transcription? These questions apply today even without texted orders, but they may come up more frequently as the discussion of this new CMS policy ramps up.

PerfectServe’s ethos revolves around partnering closely with health systems to build and implement communication and scheduling solutions that exceed their expectations.

We’ve been a leader in the healthcare communication space for over 25 years, and we’ve earned accolades from trusted industry analysts like Gartner and KLAS Research for our forward-thinking vision, our strong track record for successful deployments, and our commitment to top-notch customer service.

This commitment to delivering for customers is why we’re working to proactively address this update from CMS, recognizing both its significance and complexity.

As the healthcare landscape continues to evolve, being equipped with the latest information is crucial for health systems looking to keep up with the pace of change. Stay tuned for more about this policy—and more about the world of care team collaboration—as we navigate these changes together.