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New CMS Memorandum Regarding Texting of Orders

on Thursday, 28 March 2024 in Health Law Alert: Erin E. Busch, Editor

On February 8, 2024, CMS released updated guidance regarding the use of texting for orders. In prior guidance from 2018, CMS had stated that while it acknowledged that the use of texting had become an essential means of communication among hospital staff and providers, the texting of patient orders would not be compliant with the hospital Conditions of Participation. As the basis for its conclusions, CMS cited concerns about record retention, privacy, confidentiality, security, and the integrity of existing systems at that time. CMS noted that at that time and due to technology limitations, most hospitals did not have the ability to use secure texting platforms to incorporate text messages into the medical record.

In the updated guidance, CMS notes that while computerized physician order entry continues to be its preferred method for entering orders, it recognizes that significant improvements in encryption and the interface capabilities of texting applications now make it feasible to transfer texted orders into electronic health records. However, CMS cautions that if a hospital wishes to use such texting applications for orders, it must verify that the applications are secure and encrypted to address risks to patient privacy and confidentiality. It must also ensure the author identification functions are sufficient to maintain the integrity of the record by ensuring the authors of the orders are identified and that orders can only be entered by appropriate personnel. Finally, CMS states that in order to comply with the hospital conditions of participation, hospitals must ensure that whatever systems are utilized for orders, all orders are accurately written, promptly completed, properly filed and retained, and accessible.

This guidance now opens the door to the use of texting applications for orders, as long as the applications chosen by hospitals include appropriate safeguards to address the concerns noted above. In updating this guidance, CMS recognizes that advancements in texting application technologies may now allow hospitals to meet the conditions of participation requirements for orders. The new CMS guidance can be located HERE.

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