Secure Text Messaging in an Academic Medical Center—Experience and Lessons:
Insecure text messaging through smartphones or pagers is a growing concern at health systems. At University of Florida Health, it’s vital to balance the delivery of safe patient care and all patient privacy regulations. To proactively address the issue and provide clinical teams a safe alternative to pagers and text messaging, UF Health partnered with a preferred vendor to provide messaging and on-call scheduling.
The factors that were considered include:
• Protecting electronic patient health information (ePHI) and using HIPAA-compliant communication system standards
• Communicating securely with any type of mobile device in the organization’s directory
• Integration with third-party mobile applications and multiple mobile device management (MDM) solutions
• Access to the latest on-call schedules to reach the right individual or role
• Allow sending of images and videos along with text
• Audit trails to log the sending or receiving of communications
UF Health IT sought a vendor that took a package approach to communications –from operator console to on-call scheduling and messaging, with both clinical equipment and results communication. While many vendors did one or two of these things, UF Health IT found only one vendor that took a holistic approach to the communications upgrade.
UF Health IT pursued this vendor’s product and is currently up and running, using its standard secure messaging communication tool and its on-call scheduling system. Approximately 1,700 clinicians have signed up and are actively using the system. Early reports are that overall satisfaction is increasing during the transition period. Feedback includes: it is easier to find the physician needed and get a message to them; and People know the sender is away if the recipient hasn’t received or acknowledged the message. Anecdotes of more efficiently and quickly getting patient needs addressed continue to come in.
The upgrade was not without technical hurdles. UF Health went live on an older version of this vendor’s product and was unable to make it work within the organization. The implementation of a new version has largely addressed early problems and the company’s leadership has been very supportive in the re-implementation efforts. To remove dead-zones, wireless transmitters were added in older buildings with less-than-satisfactory wireless coverage, where cell signals for all carriers didn’t penetrate. In addition, UF Health completed a multi-year project to deploy and better integrate two large national carrier Distributed Antenna Systems (DAS) as well as to lay the groundwork for other cell carriers to utilize the systems. Creating one “clean” directory among multiple organizations proved to be the biggest technical hurdle. There were too many “sources of truth” with several different (often overlapping) employee lists, multiple active directories, etc.
Additional issues included workflow and training. Secure messaging is more than a technical project. Physician and nursing champions are vital to making such a project successful.
Workflow issues included:
• Encouraging clinicians to use personal smart phones. Departmental business administrators lent assistance with the effort. It was also challenging when departments were unable to subsidize the upgrade or when faculty members were found to still carry flip-phones.
• Signing up users and updating the system with correct information in the directory. Communication to diverse groups of faculty and staff proved extremely difficult. Sign-up sessions in common areas and during departmental meetings were helpful as were enlisting chief residents and other resident leadership. Sign up initiatives continue.
• Training the physician and nursing staff to use both the mobile system and the web system.
• Setting up appropriate escalation rules.
• Ensuring that the on-call schedule is correct and maintained in a timely manner.
Like any system implementation, secure messaging is a journey. UF Health IT teams expect these efforts to evolve into a solution that is more efficient, collaborative and responsive, and above all HIPAA compliant.