Reversing Course: Secure Text Messaging Is No Longer Permitted to Transmit Patient Care Orders

In college football, ESPN analyst Lee Corso coined the phrase “Not so fast, my friend” to foreshadow his disagreement with an on-set colleague. Often, Corso introduces the phrase when predicting an outcome contrary to popular opinion. Channeling the spirit of Corso, the Joint Commission[1] recently reversed course on the permissibility of secure text messaging to transmit patient care orders, broadcasting Corso’s message to healthcare providers —“not so fast, my friend.”

According to this publication, physicians and other licensed independent practitioners can no longer use “secure” text messages to transmit patient orders even though the Commission previously sanctioned secure texting patient orders in May of 2016. Although the Joint Commission’s previous concerns about “secure” text messages were no longer an issue, other concerns associated with the transmission of patient care orders had been raised such that using “secure” text messages is no longer permitted “at this time.”


The Joint Commission cited the following reasons to explain its decision to no longer allow secure text messages to transmit patient orders:


      1. The additional mechanism to transmit orders (secure text messaging) may lead to an increased burden on nurses to manually transcribe text orders into the electronic health records, which could adversely affect nurses’ ability to perform their critical care responsibilities;
      1. The transmission of patient orders via secure text messaging introduces an additional step because communicating a patient order verbally allows for real-time clarification and confirmation of the order; whereas, if the secure text message order is unclear, an additional step must be undertaken to contact the ordering practitioner; and
      1. If a Clinical Decision Support (“CDS”) recommendation is triggered during the manual entry of a verbal patient order, an immediate conversation can take place to determine the best course of treatment considering the CDS recommendation. The possibility of immediate clarification would not be possible if the patient order was communicated via secure text message because staff would have to contact the ordering provider seeking clarification. This additional step could result in a delay in treatment.


For now, physicians and licensed independent practitioners cannot use secure text messaging to communicate orders for patient care, treatment, or services. The position is understandable; but also somewhat inconsistent. For eample, except for eliminating the nursing inefficiency arguably created in manual transcription from secure text into the EMR, the communcaiton potential between providers entering online orders via EMR remains unchanged.

The Joint Commission has encouraged questions. If you have specific questions regarding the Joint Commission’s position, please contact: I can also help you navigate the Joint Commission’s rules and policies. Feel free to email me directly at

Lincoln Derr PLLC is a multi-specialty litigation firm focusing on translating health care law into practical and compliant clinical care.

[1] The Joint Commission is an independent, not-for-profit organization that accredits and certifies nearly 21,000 health care organizations and programs in the United States. Its mission is to continuously improve health care for the public, in collaboration with other stakeholders, by evaluating health care organizations and inspiring them to excel in providing safe and effective care of the highest quality and value.


Kevin Pratt represents health care professionals and businesses in court as a litigator and advises businesses on strategies and policies to mitigate risk.


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